Healthcare Provider Details

I. General information

NPI: 1992885909
Provider Name (Legal Business Name): DEBORAH A. RUBIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 BALBOA BLVD #200
ENCINO CA
91316-2804
US

IV. Provider business mailing address

5353 BALBOA BLVD #200
ENCINO CA
91316-2804
US

V. Phone/Fax

Practice location:
  • Phone: 818-461-9690
  • Fax: 818-461-9482
Mailing address:
  • Phone: 818-461-9690
  • Fax: 818-461-9482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG071578
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: