Provider Demographics
NPI:1679295299
Name:VITA CHIROPRACTIC M RUBINO DC INC
Entity type:Organization
Organization Name:VITA CHIROPRACTIC M RUBINO DC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:661-296-2131
Mailing Address - Street 1:27600 BOUQUET CANYON RD STE 106
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3715
Mailing Address - Country:US
Mailing Address - Phone:661-296-2131
Mailing Address - Fax:661-296-0478
Practice Address - Street 1:27600 BOUQUET CANYON RD STE 106
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-3715
Practice Address - Country:US
Practice Address - Phone:661-296-2131
Practice Address - Fax:661-296-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1326061383Medicaid