Healthcare Provider Details

I. General information

NPI: 1003728353
Provider Name (Legal Business Name): JESUS MANUEL RUBIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 VAN NESS AVE
FRESNO CA
93721-2002
US

IV. Provider business mailing address

1111 VAN NESS AVE
FRESNO CA
93721-2002
US

V. Phone/Fax

Practice location:
  • Phone: 559-265-3000
  • Fax:
Mailing address:
  • Phone: 559-265-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number220161736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: