Provider Demographics
NPI:1750562641
Name:RUBIO, LYDIA MARIE
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:MARIE
Last Name:RUBIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S MAIN ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4507
Mailing Address - Country:US
Mailing Address - Phone:714-543-4333
Mailing Address - Fax:712-543-4398
Practice Address - Street 1:500 S MAIN ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4507
Practice Address - Country:US
Practice Address - Phone:714-543-4333
Practice Address - Fax:712-543-4398
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator