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General NPI Number Information
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NPI Number | 1497943252
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Entity Type | Organization
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Legal Business Name | EDWARD RUBIN MD
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 12134 VICTORY BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3205
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Country | US
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Telephone | 818-749-7499
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Fax | 818-761-2583
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Provider Business Mailing Address
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Address Line | 12134 VICTORY BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3205
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Country | US
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Telephone | 818-749-7499
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Fax | 818-761-2583
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Authorized Official
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Title or Position | MANAGER
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Name | EUGENE FUKUMOTO
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Credential |
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Telephone | 626-299-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA11460
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA16862
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA16393
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA11867
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA15767
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G5507
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License Number State | CA
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