Healthcare Provider Details

I. General information

NPI: 1467568105
Provider Name (Legal Business Name): RONALD L. RUBENSTEIN M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13847 E 14TH ST #200
SAN LEANDRO CA
94578-2632
US

IV. Provider business mailing address

13847 E 14TH ST #200
SAN LEANDRO CA
94578-2632
US

V. Phone/Fax

Practice location:
  • Phone: 510-352-5470
  • Fax: 510-352-3154
Mailing address:
  • Phone: 510-352-5470
  • Fax: 510-352-3154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberG33407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: