Healthcare Provider Details

I. General information

NPI: 1104011154
Provider Name (Legal Business Name): EDMUNDO R. RUBIO MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16660 PARAMOUNT BLVD SUITE 205
PARAMOUNT CA
90723-5433
US

IV. Provider business mailing address

16660 PARAMOUNT BLVD SUITE 205
PARAMOUNT CA
90723-5433
US

V. Phone/Fax

Practice location:
  • Phone: 562-531-3133
  • Fax: 562-531-3204
Mailing address:
  • Phone: 562-531-3133
  • Fax: 562-531-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. EDMUNDO RICAFRENTE RUBIO
Title or Position: PHYSICIAN
Credential: MD
Phone: 562-531-3133