Provider Demographics
NPI:1730393166
Name:RUBIO, MARTHA J (MED)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:J
Last Name:RUBIO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 NIMITZ DR
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-3969
Mailing Address - Country:US
Mailing Address - Phone:847-736-4549
Mailing Address - Fax:847-297-6006
Practice Address - Street 1:1954 NIMITZ DR
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-3969
Practice Address - Country:US
Practice Address - Phone:847-736-4549
Practice Address - Fax:847-297-6006
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMR33030298P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist