Provider Demographics
NPI:1174341572
Name:RUBIO, MATIAS
Entity type:Individual
Prefix:
First Name:MATIAS
Middle Name:
Last Name:RUBIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2159 SAXE CT
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3148
Mailing Address - Country:US
Mailing Address - Phone:805-660-1457
Mailing Address - Fax:
Practice Address - Street 1:387 E AVENIDA DE LOS ARBOLES
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-2933
Practice Address - Country:US
Practice Address - Phone:805-492-1559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician