Healthcare Provider Details

I. General information

NPI: 1427078690
Provider Name (Legal Business Name): DAVID BART REUBEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 16TH ST STE 204
SANTA MONICA CA
90404-1240
US

IV. Provider business mailing address

5767 W. CENTURY BLVD. SUITE 400
LOS ANGELES CA
90045-5655
US

V. Phone/Fax

Practice location:
  • Phone: 310-319-4371
  • Fax: 310-319-4141
Mailing address:
  • Phone: 310-301-8714
  • Fax: 310-301-8712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberG66427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: