Provider Demographics
NPI:1760378087
Name:RUBIO, LIDIA SEFORA (RD)
Entity type:Individual
Prefix:MS
First Name:LIDIA
Middle Name:SEFORA
Last Name:RUBIO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 PACIFIC AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4685
Mailing Address - Country:US
Mailing Address - Phone:844-741-1888
Mailing Address - Fax:
Practice Address - Street 1:595 PACIFIC AVE FL 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4685
Practice Address - Country:US
Practice Address - Phone:844-741-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT90111133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered