Provider Demographics
NPI:1588378558
Name:RUBIO, DANIEL (BS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:RUBIO
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E TRAVIS ST STE 112
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-4280
Mailing Address - Country:US
Mailing Address - Phone:626-890-8721
Mailing Address - Fax:
Practice Address - Street 1:505 E TRAVIS ST STE 112
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-4280
Practice Address - Country:US
Practice Address - Phone:318-505-2998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management