Provider Demographics
NPI:1548256142
Name:RUBIN, CHAD (FPNP)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:RUBIN
Suffix:
Gender:M
Credentials:FPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-3353
Mailing Address - Country:US
Mailing Address - Phone:520-884-9920
Mailing Address - Fax:
Practice Address - Street 1:502 W 29TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-3353
Practice Address - Country:US
Practice Address - Phone:520-884-9920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN103936103K00000X
AZAP1598363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ741208Medicaid
72708Medicare ID - Type Unspecified
AZ741208Medicaid