Provider Demographics
NPI:1477300291
Name:GRBIC, RUBBY (MD, PA)
Entity type:Individual
Prefix:
First Name:RUBBY
Middle Name:
Last Name:GRBIC
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4129 W BUIST AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-1265
Mailing Address - Country:US
Mailing Address - Phone:480-330-2459
Mailing Address - Fax:
Practice Address - Street 1:19601 N 7TH ST UNIT 2086
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-1608
Practice Address - Country:US
Practice Address - Phone:480-330-2459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPPA724363A00000X
AZTHPA00061363A00000X
PR2102363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant