Provider Demographics
NPI:1043523079
Name:RUBALCABA, MARIA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:RUBALCABA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 LAUREL CANYON BLVD STE 560
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1569
Mailing Address - Country:US
Mailing Address - Phone:818-760-0501
Mailing Address - Fax:
Practice Address - Street 1:6400 LAUREL CANYON BLVD STE 560
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1569
Practice Address - Country:US
Practice Address - Phone:818-760-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP12400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist