Healthcare Provider Details

I. General information

NPI: 1487695003
Provider Name (Legal Business Name): MARIA CRUZ RUBIN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1172 N MACLAY AVE
SAN FERNANDO CA
91340-1328
US

IV. Provider business mailing address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

V. Phone/Fax

Practice location:
  • Phone: 818-898-1388
  • Fax: 818-270-9590
Mailing address:
  • Phone: 612-873-6005
  • Fax: 612-630-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number83144
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: