MEDICARE: GABRIELA 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	106H00000X	Marriage & Family Therapist	107734	CA

General Provider Information

NPI Number	:	1225572746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELA RUBIO

Provider Business Mailing Address
First Line	:	2677 ZOE AVE STE 114
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-6995
Country	:	US
Telephone Number	:	323-923-9559
Fax Number	:

Provider Business Practice Location Address
First Line	:	2677 ZOE AVE STE 114
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-6995
Country	:	US
Telephone Number	:	323-923-9559
Fax Number	:	323-923-9566

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

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	09/14/2018

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