Healthcare Provider Details

I. General information

NPI: 1992876403
Provider Name (Legal Business Name): MARK M RUBENSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 LOS ALTOS AVE
WALNUT CREEK CA
94598-3117
US

IV. Provider business mailing address

147 LOS ALTOS AVE
WALNUT CREEK CA
94598-3117
US

V. Phone/Fax

Practice location:
  • Phone: 925-932-6650
  • Fax: 925-937-6650
Mailing address:
  • Phone: 925-932-6650
  • Fax: 925-937-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA20200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: