MEDICARE: MR. JORGE DUBIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	A24464	CA
2	2084P0800X	Psychiatry Physician	A24464	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A24464	OTHER	CA	CA LICENSE NUMBER

General Provider Information

NPI Number	:	1497845614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JORGE DUBIN MD

Provider Business Mailing Address
First Line	:	4010 WATSON PLAZA DR
Second Line	:	SUITE 285
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-4037
Country	:	US
Telephone Number	:	562-497-1505
Fax Number	:	562-497-1881

Provider Business Practice Location Address
First Line	:	4010 WATSON PLAZA DR
Second Line	:	SUITE 285
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-4037
Country	:	US
Telephone Number	:	562-497-1505
Fax Number	:	562-497-1881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	08/14/2013

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