Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 86955 | CA |
NPI | 1003169723 |
---|---|
Provider Name | Jeniffer Michelle Rubio |
First Address | Long Beach, CA 90806-2325 |
Second Address | Long Beach, CA 90806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2012 |
Last Update Date | 20/12/2018 |