Healthcare Provider Details

I. General information

NPI: 1528146339
Provider Name (Legal Business Name): ELIZABETH P. RUBIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 PEAR TREE LN STE 100
NAPA CA
94558-6485
US

IV. Provider business mailing address

1141 PEAR TREE LN STE 100
NAPA CA
94558-6485
US

V. Phone/Fax

Practice location:
  • Phone: 707-254-1770
  • Fax: 707-254-1779
Mailing address:
  • Phone: 707-254-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG85647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: