Healthcare Provider Details

I. General information

NPI: 1790388486
Provider Name (Legal Business Name): TESSA ROSE RUBIN MS, RN, NP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 BERRY ST
SAN FRANCISCO CA
94107-5705
US

IV. Provider business mailing address

185 BERRY ST
SAN FRANCISCO CA
94107-5705
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-4533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95172479
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95015803
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: