MEDICARE: EMILIO RUBALCAVA JR.

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	106H00000X	Marriage & Family Therapist		CA
2	101Y00000X	Counselor
3	106H00000X	Marriage & Family Therapist	137671	CA

General Provider Information

NPI Number	:	1932639861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILIO RUBALCAVA JR.

Provider Business Mailing Address
First Line	:	1218 BROADWAY
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-2408
Country	:	US
Telephone Number	:	951-306-8210
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 SHAFFER RD BLDG 1
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-5761
Country	:	US
Telephone Number	:	831-466-9307
Fax Number	:

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

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	02/09/2026

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