Provider Demographics
NPI:1649920257
Name:RUBIE, JENNA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:RUBIE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6075 KELTON AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2728
Mailing Address - Country:US
Mailing Address - Phone:425-221-2619
Mailing Address - Fax:
Practice Address - Street 1:6075 KELTON AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2728
Practice Address - Country:US
Practice Address - Phone:425-221-2619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-26
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA794731163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant