Provider Demographics
NPI:1730162629
Name:DUBRULE, NADINE B (MD)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:B
Last Name:DUBRULE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5426
Mailing Address - Country:US
Mailing Address - Phone:575-887-2455
Mailing Address - Fax:575-234-2945
Practice Address - Street 1:2013 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5426
Practice Address - Country:US
Practice Address - Phone:575-887-2455
Practice Address - Fax:575-234-2945
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2009-0215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30204957Medicaid
RE8168Medicare ID - Type Unspecified
NH30204957Medicaid