MEDICARE: IVONNE RUBIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1063974210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVONNE RUBIO

Provider Business Mailing Address
First Line	:	1465 BEACHWOOD DR APT B
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95407-7063
Country	:	US
Telephone Number	:	760-620-1554
Fax Number	:

Provider Business Practice Location Address
First Line	:	246 BRITTAIN LN
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-5810
Country	:	US
Telephone Number	:	707-525-8350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2019
Last Update Date	:	05/18/2026

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Directions to “ IVONNE RUBIO ” Practice Location

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