Healthcare Provider Details

I. General information

NPI: 1649302902
Provider Name (Legal Business Name): STUART B DUBIN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

31255 CEDAR VALLEY DR SUITE 324
WESTLAKE VILLAGE CA
91362-4014
US

V. Phone/Fax

Practice location:
  • Phone: 808-338-8103
  • Fax: 818-338-8119
Mailing address:
  • Phone: 808-338-8103
  • Fax: 818-338-8119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberG44574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: