Healthcare Provider Details

I. General information

NPI: 1326041005
Provider Name (Legal Business Name): SETH ISAIAH RUBIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019A WEBSTER ST
SAN FRANCISCO CA
94115-2329
US

IV. Provider business mailing address

PO BOX 3118
SAUSALITO CA
94966-3118
US

V. Phone/Fax

Practice location:
  • Phone: 415-771-5115
  • Fax: 415-887-9412
Mailing address:
  • Phone: 415-771-5115
  • Fax: 415-887-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 7097
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPSY 7097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: