=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700463775
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TODD GABRIEL RUBIN MD, PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2021
-----------------------------------------------------
Last Update Date | 07/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1260 15TH ST STE 1024
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404-1145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-259-8570
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5767 W CENTURY BLVD STE 400
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90045-5631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-301-8707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0008X
-----------------------------------------------------
Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | A201401
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------