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Individual

ANA D RUBALCABA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
8110 MANGO AVE, FONTANA, CA 92335-3603
(909) 822-1164
Mailing address
PO BOX 12209, SAN BERNARDINO, CA 92423-2209
(909) 335-4188

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA22007
CA
363AM0700X
Medical Physician Assistant
Primary
PA22007
CA

Other

Enumeration date
02/07/2012
Last updated
11/23/2021
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