Healthcare Provider Details

I. General information

NPI: 1295941383
Provider Name (Legal Business Name): RUBIO R. PUNZALAN, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 S GRAND OAKS AVE
PASADENA CA
91107-5011
US

IV. Provider business mailing address

427 S GRAND OAKS AVE
PASADENA CA
91107-5011
US

V. Phone/Fax

Practice location:
  • Phone: 626-201-9893
  • Fax:
Mailing address:
  • Phone: 626-201-9893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA66411
License Number StateCA

VIII. Authorized Official

Name: DR. RUBIO REYES PUNZALAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-201-9893