Provider Demographics
NPI:1780478024
Name:RUBIO, LEA KARLLA BERNABE
Entity type:Individual
Prefix:
First Name:LEA KARLLA
Middle Name:BERNABE
Last Name:RUBIO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 LIVORNA HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-1324
Mailing Address - Country:US
Mailing Address - Phone:510-508-1476
Mailing Address - Fax:
Practice Address - Street 1:269 LIVORNA HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:CA
Practice Address - Zip Code:94507-1324
Practice Address - Country:US
Practice Address - Phone:510-508-1476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily