Provider Demographics
NPI:1700904489
Name:RUBIO, IRVIN MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:IRVIN
Middle Name:MANUEL
Last Name:RUBIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 CALLE ALMENDRO
Mailing Address - Street 2:LOS COLOBOS PARK
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-8305
Mailing Address - Country:US
Mailing Address - Phone:787-657-4558
Mailing Address - Fax:
Practice Address - Street 1:1969 SUNSET PIONT RD #15
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765
Practice Address - Country:US
Practice Address - Phone:727-443-7978
Practice Address - Fax:877-989-3173
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16765208D00000X
FLACN1325208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0028104Medicare PIN