Provider Demographics
NPI:1073291209
Name:RUBCIC, KARLIANNE NICOLE
Entity type:Individual
Prefix:
First Name:KARLIANNE
Middle Name:NICOLE
Last Name:RUBCIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-3311
Mailing Address - Country:US
Mailing Address - Phone:510-292-7049
Mailing Address - Fax:650-877-5701
Practice Address - Street 1:350 90TH ST FL 3
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1879
Practice Address - Country:US
Practice Address - Phone:650-877-5700
Practice Address - Fax:650-877-5701
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 390200000X
CA148938106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No172V00000XOther Service ProvidersCommunity Health Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program