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General NPI Number Information
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NPI Number | 1346236205
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Entity Type | Individual
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Provider Name | JACK E RUBIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 05/03/2008
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Provider Practice Location Address
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Address Line | 575 E HARDY ST SUITE 322
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City | INGLEWOOD
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State | CA
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Zip | 90301-4036
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Country | US
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Telephone | 310-671-0488
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Fax | 310-671-7618
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Provider Business Mailing Address
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Address Line | PO BOX 260458
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City | ENCINO
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State | CA
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Zip | 91426-0458
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Country | US
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Telephone | 818-784-4201
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Fax | 818-784-4206
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | G060194
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License Number State | CA
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