Healthcare Provider Details

I. General information

NPI: 1417299702
Provider Name (Legal Business Name): GUSTAVO RUBIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9195 SUNSET DR STE 230
MIAMI FL
33173-3488
US

IV. Provider business mailing address

9195 SW 72ND ST STE 230
MIAMI FL
33173-3488
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-0300
  • Fax:
Mailing address:
  • Phone: 786-466-6960
  • Fax: 305-279-1994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME143977
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME143977
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: