Provider Demographics
NPI:1831872704
Name:RUBIO, DAVID JR (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:RUBIO
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 S FORT HARRISON AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-2504
Mailing Address - Country:US
Mailing Address - Phone:727-746-5812
Mailing Address - Fax:
Practice Address - Street 1:1465 S FORT HARRISON AVE STE 204
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-2504
Practice Address - Country:US
Practice Address - Phone:727-746-5812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.011243103TC0700X
FLPY11904103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical