MEDICARE: ELIZABETH RUBIO LCSW

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	1041C0700X	Clinical Social Worker	102028	CA

General Provider Information

NPI Number	:	1659791382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH RUBIO LCSW

Provider Business Mailing Address
First Line	:	1110 N VIRGIL AVE
Second Line	:	PMB 96396
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2016
Country	:	US
Telephone Number	:	818-217-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 N VIRGIL AVE
Second Line	:	PMB 96396
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2016
Country	:	US
Telephone Number	:	818-217-0550
Fax Number	:

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

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	07/31/2023

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