Healthcare Provider Details

I. General information

NPI: 1275372062
Provider Name (Legal Business Name): LAQUANDA RUBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

IV. Provider business mailing address

16455 NELSON PARK DR APT 306B
CLERMONT FL
34714-5866
US

V. Phone/Fax

Practice location:
  • Phone: 352-901-4009
  • Fax:
Mailing address:
  • Phone: 520-732-6217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: