Healthcare Provider Details

I. General information

NPI: 1538180575
Provider Name (Legal Business Name): MARRIETH GARCIELA RUBIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RIVERSIDE CIRCLE VA GULF COAST HEALTHCARE SYSTEM (111)
ROANOKE VA
24016
US

IV. Provider business mailing address

3 RIVERSIDE CIRCLE
ROANOKE VA
24016
US

V. Phone/Fax

Practice location:
  • Phone: 540-224-5170
  • Fax: 540-983-8229
Mailing address:
  • Phone: 540-224-5170
  • Fax: 540-983-8229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number12454R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number12454R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: