Provider Demographics
NPI:1891393377
Name:RUBIO, TERESA MARLENA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARLENA
Last Name:RUBIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1797 SAN JOSE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-3078
Mailing Address - Country:US
Mailing Address - Phone:559-298-0699
Mailing Address - Fax:
Practice Address - Street 1:3239 E TENAYA WAY
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5924
Practice Address - Country:US
Practice Address - Phone:559-298-0697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor