Active NPI
Mauricio Rubio
- Endodontics
- Fresno, CA
National Provider Identifier
1336752971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 105354
- Practice address
- 5336 E Truman Ave
Fresno, CA 93725-0934 - Phone
- (559) 824-3188
- NPI assigned
- Aug 24, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 105354 | CA | |
| Endodontics | 1223E0200X | 105354 | CA | Primary |
Addresses
Primary practice location
5336 E Truman Ave
Fresno, CA 93725-0934
Mailing address
5336 E Truman Ave
Fresno, CA 93725-0934
Phone (559) 824-3188
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201025000014 | CA | Order and Referring Only - Dentist | 4688094089 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105354 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723161600000",
"number": "1336752971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5336 E TRUMAN AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937250934",
"telephone_number": "559-824-3188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5336 E TRUMAN AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937250934",
"telephone_number": "559-824-3188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUBIO",
"first_name": "MAURICIO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-08-24",
"last_updated": "2024-08-09",
"certification_date": "2024-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "CA",
"license": "105354",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "105354",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.