Healthcare Provider Details

I. General information

NPI: 1427003003
Provider Name (Legal Business Name): LAWRENCE R ROUBEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28400 MCCALL BLVD
MENIFEE CA
92585-9658
US

IV. Provider business mailing address

3805 SAN DIMAS ST STE B
BAKERSFIELD CA
93301-5725
US

V. Phone/Fax

Practice location:
  • Phone: 661-432-3694
  • Fax:
Mailing address:
  • Phone: 803-592-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG73813
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG73813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: