=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154816205
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISS YESENIA RUBIO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2018
-----------------------------------------------------
Last Update Date | 06/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 114 B ST
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95334-9596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-216-8257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6878 BETH CIR
-----------------------------------------------------
City | WINTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95388-9205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-354-9385
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------