Provider Demographics
NPI:1598572901
Name:RUBIO, EZRA ROBERTO (LAT)
Entity type:Individual
Prefix:
First Name:EZRA
Middle Name:ROBERTO
Last Name:RUBIO
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 E FLYNN AVE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-4349
Mailing Address - Country:US
Mailing Address - Phone:956-345-9787
Mailing Address - Fax:
Practice Address - Street 1:600 N JACKSON RD
Practice Address - Street 2:
Practice Address - City:HIDALGO
Practice Address - State:TX
Practice Address - Zip Code:78557-3814
Practice Address - Country:US
Practice Address - Phone:956-340-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT93672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer