Healthcare Provider Details

I. General information

NPI: 1366235384
Provider Name (Legal Business Name): PAMELA PRAXEDES RUBIO AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 YORK AVE, 9TH FLOOR
NEW YORK NY
10065
US

IV. Provider business mailing address

1283 YORK AVE, 9TH FLOOR
NEW YORK NY
10065
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number312123
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: