Provider Demographics
NPI:1245363944
Name:RUBIO, IRIS (LMFT)
Entity type:Individual
Prefix:MISS
First Name:IRIS
Middle Name:
Last Name:RUBIO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3005
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-1905
Mailing Address - Country:US
Mailing Address - Phone:323-588-5821
Mailing Address - Fax:
Practice Address - Street 1:12501 IMPERIAL HWY STE 400
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-1419
Practice Address - Country:US
Practice Address - Phone:562-807-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF48475106H00000X
CALMFT46574106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist