Healthcare Provider Details

I. General information

NPI: 1285815035
Provider Name (Legal Business Name): GEROLESCENCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 MILL ST
RENO NV
89502-1320
US

IV. Provider business mailing address

3495 LAKESIDE DR #176
RENO NV
89509-4841
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-1019
  • Fax: 775-329-1564
Mailing address:
  • Phone: 775-329-1019
  • Fax: 775-329-1564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number6827
License Number StateNV

VIII. Authorized Official

Name: DR. STEVEN E RUBIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 775-329-1019