Provider Demographics
NPI:1285705426
Name:RUBIN, RITA CAREY (MS, RD, CDE)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:CAREY
Last Name:RUBIN
Suffix:
Gender:
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1641
Mailing Address - Country:US
Mailing Address - Phone:928-771-5794
Mailing Address - Fax:928-771-5351
Practice Address - Street 1:68 HARRISON AVE STE 605
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1929
Practice Address - Country:US
Practice Address - Phone:888-404-4813
Practice Address - Fax:888-675-4061
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074.0134583133N00000X
IA128911133V00000X
HI438-LD133V00000X
NH1963133V00000X
NY011591133V00000X
OHLD.10671133V00000X
DEDN-0011221133V00000X
UT14193767-4901133V00000X
AL5607133V00000X
MO2024030003133V00000X
AK225584133V00000X
MEDI2000133V00000X
NMNDP-2024-0078133V00000X
SC3197133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ773102Medicaid
AZ710000859OtherRAILROAD MEDICARE
AZ773102Medicaid