Healthcare Provider Details

I. General information

NPI: 1194437459
Provider Name (Legal Business Name): SARA MARIE RUBIO APRN CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9410 NE ZAC LENTZ PKWY STE 202
VICTORIA TX
77904-3172
US

IV. Provider business mailing address

56 SADDLEHORN DR
PORT LAVACA TX
77979-5234
US

V. Phone/Fax

Practice location:
  • Phone: 361-579-1333
  • Fax: 361-579-1334
Mailing address:
  • Phone: 361-676-6977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1097691
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: