Healthcare Provider Details

I. General information

NPI: 1194749341
Provider Name (Legal Business Name): MARK LESLIE RUBIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 S. MCCLINTOCK DR.#105
TEMPE AZ
85282
US

IV. Provider business mailing address

PO BOX 11417
TEMPE AZ
85284-0024
US

V. Phone/Fax

Practice location:
  • Phone: 480-284-7304
  • Fax: 480-284-7616
Mailing address:
  • Phone: 480-284-7304
  • Fax: 480-284-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License Number18801
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number18801
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number18801
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: