Provider Demographics
NPI:1871622829
Name:RUBIO, MARIO A (LSA)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:A
Last Name:RUBIO
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2715 FERRY LNDG
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4314
Mailing Address - Country:US
Mailing Address - Phone:713-254-3010
Mailing Address - Fax:281-416-4225
Practice Address - Street 1:2715 FERRY LNDG
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4314
Practice Address - Country:US
Practice Address - Phone:713-254-3010
Practice Address - Fax:281-416-4225
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXSA00141363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical