Healthcare Provider Details

I. General information

NPI: 1649517590
Provider Name (Legal Business Name): MARIA L RUBOLINO-GALLEGO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2013
Last Update Date: 01/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 EYE ST SUITE 110
BAKERSFIELD CA
93301-2064
US

IV. Provider business mailing address

11806 BUFFINGTON ST
BAKERSFIELD CA
93312-4685
US

V. Phone/Fax

Practice location:
  • Phone: 661-637-0137
  • Fax:
Mailing address:
  • Phone: 661-587-5859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number12605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: