Healthcare Provider Details

I. General information

NPI: 1912188764
Provider Name (Legal Business Name): DANIEL RUBIO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 MURCHISON DR
EL PASO TX
79902-2921
US

IV. Provider business mailing address

1720 MURCHISON DR
EL PASO TX
79902-2921
US

V. Phone/Fax

Practice location:
  • Phone: 915-534-1319
  • Fax:
Mailing address:
  • Phone: 915-534-1319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2007-0037
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: