Healthcare Provider Details

I. General information

NPI: 1497742084
Provider Name (Legal Business Name): MARK ALLEN RUBEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CHADBOURNE RD 201
FAIRFIELD CA
94534-9647
US

IV. Provider business mailing address

2290 SACRAMENTO ST
VALLEJO CA
94590-2929
US

V. Phone/Fax

Practice location:
  • Phone: 707-399-4500
  • Fax: 707-643-8810
Mailing address:
  • Phone: 707-643-5785
  • Fax: 707-643-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG75891
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG75891
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberG75891
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: