MEDICARE: STEPHANIE J RUBI

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	207N00000X	Dermatology Physician	L8497	CA

General Provider Information

NPI Number	:	1295200509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE J RUBI

Provider Business Mailing Address
First Line	:	110 N MOUNTAIN AVE
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-4540
Country	:	US
Telephone Number	:	951-264-6098
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 S INDIAN HILL BLVD
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-5224
Country	:	US
Telephone Number	:	909-624-8617
Fax Number	:

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

Provider Enumeration Date	:	10/12/2018
Last Update Date	:	10/12/2018

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