Healthcare Provider Details

I. General information

NPI: 1780557546
Provider Name (Legal Business Name): CHANTAL RUBIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RIVERSIDE PLAZA LN NW STE 100
ALBUQUERQUE NM
87120-2682
US

IV. Provider business mailing address

1236 SW 104TH CT
MIAMI FL
33174-2609
US

V. Phone/Fax

Practice location:
  • Phone: 505-322-6687
  • Fax: 505-369-3406
Mailing address:
  • Phone: 786-650-7240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11042494
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: