Healthcare Provider Details

I. General information

NPI: 1366817470
Provider Name (Legal Business Name): ERICK RUBIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4816 E 3RD ST
EAST LOS ANGELES CA
90022-1602
US

IV. Provider business mailing address

PO BOX 213
LA PUENTE CA
91747-0213
US

V. Phone/Fax

Practice location:
  • Phone: 323-780-4510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number90206
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127671
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number90206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: