MEDICARE: CIARYS RUBIO JUNG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	109807	TX
2	1041C0700X	Clinical Social Worker	103995	CA

General Provider Information

NPI Number	:	1215690516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CIARYS RUBIO JUNG

Provider Business Mailing Address
First Line	:	3440 RANCH TRL APT 2423
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-2445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3440 RANCH TRL APT 2423
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-2445
Country	:	US
Telephone Number	:	323-366-9561
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2021
Last Update Date	:	03/30/2023

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