Healthcare Provider Details

I. General information

NPI: 1639458268
Provider Name (Legal Business Name): PAUL KEITH RUBIA LPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2011
Last Update Date: 08/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9864 BALDWIN PL
EL MONTE CA
91731-2202
US

IV. Provider business mailing address

8461 VALLEY VIEW ST
BUENA PARK CA
90620-2739
US

V. Phone/Fax

Practice location:
  • Phone: 626-433-1316
  • Fax:
Mailing address:
  • Phone: 714-232-5605
  • Fax: 714-826-7271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT35590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: