Healthcare Provider Details

I. General information

NPI: 1376577411
Provider Name (Legal Business Name): ROY MOSHE RUBIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY AVE #100
SACRAMENTO CA
95825
US

IV. Provider business mailing address

2443 FAIR OAKS BLVD #527
SACRAMENTO CA
95825
US

V. Phone/Fax

Practice location:
  • Phone: 916-437-0570
  • Fax: 916-437-0470
Mailing address:
  • Phone: 916-437-0570
  • Fax: 916-437-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA787530
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA78753
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberA78753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: