Basic Information
| Provider Information | |||||||||
| NPI: | 1891393377 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUBIO | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | MARLENA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1797 SAN JOSE AVE | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936113078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592980699 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3239 E TENAYA WAY | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937105924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592980697 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2020 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.