Healthcare Provider Details

I. General information

NPI: 1902727118
Provider Name (Legal Business Name): VICTORIA JESSICA RUBIO CADC-11
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15028 DICKENS ST APT 5
SHERMAN OAKS CA
91403-3497
US

IV. Provider business mailing address

15028 DICKENS ST APT 5
SHERMAN OAKS CA
91403-3497
US

V. Phone/Fax

Practice location:
  • Phone: 310-227-5293
  • Fax:
Mailing address:
  • Phone: 310-227-5293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAII063850426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: