Healthcare Provider Details

I. General information

NPI: 1972123180
Provider Name (Legal Business Name): SOFI RUBIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 W 7TH ST
LOS ANGELES CA
90057-4002
US

IV. Provider business mailing address

PO BOX
LOS ANGELES CA
90074-9399
US

V. Phone/Fax

Practice location:
  • Phone: 213-384-3434
  • Fax:
Mailing address:
  • Phone: 213-399-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: