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General NPI Number Information
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NPI Number | 1275372062
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Entity Type | Individual
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Provider Name | LAQUANDA RUBIN
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Gender | Female
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Dates
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Enumeration Date | 05/21/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 425 W COLONIAL DR STE 303
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City | ORLANDO
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State | FL
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Zip | 32804-6863
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Country | US
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Telephone | 352-901-4009
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Fax |
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Provider Business Mailing Address
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Address Line | 16455 NELSON PARK DR APT 306B
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City | CLERMONT
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State | FL
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Zip | 34714-5866
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Country | US
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Telephone | 520-732-6217
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number |
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License Number State |
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