MEDICARE: RUTH RUBIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G55162	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48-1269385	OTHER	CA	TAX ID#

General Provider Information

NPI Number	:	1043238041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH RUBIN M.D.

Provider Business Mailing Address
First Line	:	21 TAMAL VISTA BLVD
Second Line	:	STE. 100
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1130
Country	:	US
Telephone Number	:	415-927-0101
Fax Number	:	415-927-5310

Provider Business Practice Location Address
First Line	:	21 TAMAL VISTA BLVD
Second Line	:	STE. 100
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1130
Country	:	US
Telephone Number	:	415-927-0101
Fax Number	:	415-927-5310

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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Directions to “ RUTH RUBIN M.D.” Practice Location

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