Healthcare Provider Details

I. General information

NPI: 1952795023
Provider Name (Legal Business Name): ESTELA GREGORIA RUBIN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 9TH AVE
TRUTH OR CONSEQUENCES NM
87901-1954
US

IV. Provider business mailing address

800 E 9TH AVE
TRUTH OR CONSEQUENCES NM
87901-1954
US

V. Phone/Fax

Practice location:
  • Phone: 575-894-2111
  • Fax: 575-894-7659
Mailing address:
  • Phone: 575-894-2111
  • Fax: 575-894-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02644
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: