Healthcare Provider Details

I. General information

NPI: 1093446478
Provider Name (Legal Business Name): EMILY ARLENE RUBIO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6745 N 51ST DR
GLENDALE AZ
85301-3425
US

IV. Provider business mailing address

6745 N 51ST DR
GLENDALE AZ
85301-3425
US

V. Phone/Fax

Practice location:
  • Phone: 623-847-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: