Healthcare Provider Details

I. General information

NPI: 1891751772
Provider Name (Legal Business Name): RAUL ERNESTO RUBIO SR. FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 S MERCY RD STE 300
GILBERT AZ
85297-0425
US

IV. Provider business mailing address

3420 S MERCY RD STE 300
GILBERT AZ
85297-0425
US

V. Phone/Fax

Practice location:
  • Phone: 480-955-0900
  • Fax: 480-955-0800
Mailing address:
  • Phone: 480-955-0900
  • Fax: 480-955-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP7764
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: