Healthcare Provider Details

I. General information

NPI: 1568940286
Provider Name (Legal Business Name): KATERY A RUBIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 WEAVER LN
LOS ANGELES CA
90042-1918
US

IV. Provider business mailing address

2677 N MAIN ST STE 130
SANTA ANA CA
92705-6665
US

V. Phone/Fax

Practice location:
  • Phone: 510-367-4522
  • Fax:
Mailing address:
  • Phone: 800-801-9833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: