Healthcare Provider Details

I. General information

NPI: 1649425026
Provider Name (Legal Business Name): RUBEN S. CASABAR, M.D, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6021 ATLANTIC BLVD
MAYWOOD CA
90270-3118
US

IV. Provider business mailing address

6021 ATLANTIC BLVD
MAYWOOD CA
90270-3118
US

V. Phone/Fax

Practice location:
  • Phone: 323-484-9590
  • Fax: 323-457-9103
Mailing address:
  • Phone: 323-484-9590
  • Fax: 323-457-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA47793
License Number StateCA

VIII. Authorized Official

Name: DR. RUBEN SANGALANG CASABAR
Title or Position: OWNER
Credential: MD
Phone: 323-484-9590