Healthcare Provider Details

I. General information

NPI: 1740521079
Provider Name (Legal Business Name): FELIPE RUBIO CAPIRAL JR. OTR, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RUGBY AVE
HUNTINGTON PARK CA
90255-4066
US

IV. Provider business mailing address

6330 RUGBY AVE
HUNTINGTON PARK CA
90255-4066
US

V. Phone/Fax

Practice location:
  • Phone: 323-277-7678
  • Fax:
Mailing address:
  • Phone: 323-277-7678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number128531
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 8306
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: