Healthcare Provider Details

I. General information

NPI: 1235768730
Provider Name (Legal Business Name): CHELSEA TIME RUBIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 VOLVO PKWY STE 100
CHESAPEAKE VA
23320-3341
US

IV. Provider business mailing address

860 OMNI BLVD STE 128
NEWPORT NEWS VA
23606-4483
US

V. Phone/Fax

Practice location:
  • Phone: 757-410-3231
  • Fax:
Mailing address:
  • Phone: 757-964-8739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102208109
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: