Healthcare Provider Details

I. General information

NPI: 1982894572
Provider Name (Legal Business Name): LAWRENCE I RUBIN DPM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 W REDONDO BEACH BLVD STE 106
GARDENA CA
90247-4276
US

IV. Provider business mailing address

1045 W REDONDO BEACH BLVD STE 106
GARDENA CA
90247-4276
US

V. Phone/Fax

Practice location:
  • Phone: 310-323-2887
  • Fax: 310-323-8609
Mailing address:
  • Phone: 310-323-2887
  • Fax: 310-323-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1602
License Number StateCA

VIII. Authorized Official

Name: LAWRENCE RUBIN
Title or Position: DIRECTOR
Credential:
Phone: 310-323-2887