MEDICARE: GABRIEL V RUBANENKO 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	207X00000X	Orthopaedic Surgery Physician	A39466	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194704643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL V RUBANENKO M.D.

Provider Business Mailing Address
First Line	:	6200 WILSHIRE BLVD
Second Line	:	SUITE 908
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5801
Country	:	US
Telephone Number	:	323-965-5088
Fax Number	:	310-274-1040

Provider Business Practice Location Address
First Line	:	6200 WILSHIRE BLVD
Second Line	:	SUITE 910
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5801
Country	:	US
Telephone Number	:	323-965-5088
Fax Number	:	310-274-1040

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	03/01/2010

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