Provider Demographics
NPI:1124916952
Name:RUBIO, JUAN ANTONIO JR
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ANTONIO
Last Name:RUBIO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6925 CANOGA AVE
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2032
Mailing Address - Country:US
Mailing Address - Phone:818-312-7110
Mailing Address - Fax:
Practice Address - Street 1:8540 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-6142
Practice Address - Country:US
Practice Address - Phone:818-312-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker