Provider Demographics
NPI:1972673366
Name:RUBIO, MARIAN F (MA)
Entity type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:F
Last Name:RUBIO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 VIEWRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-3133
Mailing Address - Country:US
Mailing Address - Phone:210-364-8663
Mailing Address - Fax:210-349-6207
Practice Address - Street 1:4203 WOODCOCK DR STE 265
Practice Address - Street 2:4603 MANITOU ST. #210
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1312
Practice Address - Country:US
Practice Address - Phone:210-364-8663
Practice Address - Fax:210-349-6207
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9443101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095414106Medicaid
TX83799LOtherAO BCBS