Healthcare Provider Details

I. General information

NPI: 1780478024
Provider Name (Legal Business Name): LEA KARLLA BERNABE RUBIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 LIVORNA HEIGHTS RD
ALAMO CA
94507-1324
US

IV. Provider business mailing address

269 LIVORNA HEIGHTS RD
ALAMO CA
94507-1324
US

V. Phone/Fax

Practice location:
  • Phone: 510-508-1476
  • Fax:
Mailing address:
  • Phone: 510-508-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95034532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: