Healthcare Provider Details

I. General information

NPI: 1922472273
Provider Name (Legal Business Name): MS. RUBELYNN BOCOG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 7TH AVE
SAN BRUNO CA
94066-4522
US

IV. Provider business mailing address

1001 SNEATH LN STE 307
SAN BRUNO CA
94066-2349
US

V. Phone/Fax

Practice location:
  • Phone: 650-204-3113
  • Fax: 650-634-8717
Mailing address:
  • Phone: 650-244-1444
  • Fax: 650-244-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: