MEDICARE: JUANITA MILDRED 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

General Provider Information

NPI Number	:	1831800960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANITA MILDRED RUBIO LCSW

Provider Business Mailing Address
First Line	:	1912 TIM FOSTER ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-3215
Country	:	US
Telephone Number	:	915-781-9702
Fax Number	:

Provider Business Practice Location Address
First Line	:	1475 RAYNOLDS ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79903-3251
Country	:	US
Telephone Number	:	718-298-3822
Fax Number	:

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

Provider Enumeration Date	:	12/09/2022
Last Update Date	:	12/09/2022

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