Basic Information
| Provider Information | |||||||||
| NPI: | 1225769854 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUBIO | ||||||||
| FirstName: | JOANNA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1345 N FRIES AVE | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907442510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109844143 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10929 SOUTH ST STE 208B | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907035391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629245526 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2022 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YM0800X | 108838 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.