Healthcare Provider Details

I. General information

NPI: 1437548716
Provider Name (Legal Business Name): LESLIE FAY RUBIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V STREET, PSSB STE 1200 UCDMC DEPT OF ANESTHESIOLOGY & PAIN MEDICINE
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

1212 J ST
DAVIS CA
95616-2131
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5028
  • Fax:
Mailing address:
  • Phone: 707-217-7166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number776659 RN
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: