Provider Demographics
NPI:1386128965
Name:RUBIO-DOMINGUEZ, PEDRO EDUARDO
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:EDUARDO
Last Name:RUBIO-DOMINGUEZ
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 1:10484 VALLEY BLVD SPC 75
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2437
Mailing Address - Country:US
Mailing Address - Phone:626-863-2017
Mailing Address - Fax:
Practice Address - Street 1:10484 VALLEY BLVD SPC 75
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2437
Practice Address - Country:US
Practice Address - Phone:626-863-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40876167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician