Basic Information
| Provider Information | |||||||||
| NPI: | 1639520935 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUBIO | ||||||||
| FirstName: | SERGIO | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 E MICHELTORENA ST STE C | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931034223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055633234 | ||||||||
| FaxNumber: | 8055698358 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 E MICHELTORENA ST STE C | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931034223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056182109 | ||||||||
| FaxNumber: | 8053246315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2016 | ||||||||
| LastUpdateDate: | 12/30/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/30/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A154284 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | A154284 | 01 | CA | MEDICAL BOARD OF CALIFORNIA | OTHER |