Provider Demographics
NPI:1245489749
Name:RUBIO, TATIANA MARIA (LAC)
Entity type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:MARIA
Last Name:RUBIO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:TATIANA
Other - Middle Name:MARIA
Other - Last Name:TANENBAUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:2277 TOWNSGATE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2423
Mailing Address - Country:US
Mailing Address - Phone:310-367-5086
Mailing Address - Fax:
Practice Address - Street 1:2277 TOWNSGATE RD STE 220
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2423
Practice Address - Country:US
Practice Address - Phone:310-367-5086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7838171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 7839OtherACUPUNCTURE LICENSE NUMBER