Provider Demographics
NPI:1902994270
Name:RUBIO, CHARLES T (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:T
Last Name:RUBIO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2114 EXECUTIVE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-6042
Mailing Address - Country:US
Mailing Address - Phone:334-749-5055
Mailing Address - Fax:334-460-8900
Practice Address - Street 1:2114 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-6042
Practice Address - Country:US
Practice Address - Phone:334-749-5055
Practice Address - Fax:334-460-8900
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL220103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR35816Medicare UPIN