Provider Demographics
NPI:1932639861
Name:RUBALCAVA, EMILIO JR
Entity Type:Individual
Prefix:
First Name:EMILIO
Middle Name:
Last Name:RUBALCAVA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2408
Mailing Address - Country:US
Mailing Address - Phone:951-306-8210
Mailing Address - Fax:
Practice Address - Street 1:8767 CARMEL VALLEY RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-7958
Practice Address - Country:US
Practice Address - Phone:831-582-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA106H00000X
CA137671106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor