Healthcare Provider Details

I. General information

NPI: 1437888088
Provider Name (Legal Business Name): LAWRENCE I RUBIN DPM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/08/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20911 EARL ST STE 290
TORRANCE CA
90503-4354
US

IV. Provider business mailing address

1045 W REDONDO BEACH BLVD STE 106
GARDENA CA
90247-4276
US

V. Phone/Fax

Practice location:
  • Phone: 310-792-5670
  • Fax:
Mailing address:
  • Phone: 310-323-2887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: KELLY YU
Title or Position: PRESIDENT
Credential: DPM
Phone: 310-323-2887