MEDICARE: DR. JACOB NATHAN 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	207RI0011X	Interventional Cardiology Physician	G53079	CA
2	207RC0000X	Cardiovascular Disease Physician	G53079	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	W20900	OTHER	CA	MEDICARE GROUP NUMBER
5	060011851	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ94648Z	OTHER	CA	BLUE SHEILD
2	95354702891403B004	OTHER	CA	TRICARE WEST REGION
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437151180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB NATHAN RUBIN M.D.

Provider Business Mailing Address
First Line	:	4940 VAN NUYS BLVD
Second Line	:	SUITE 200
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1741
Country	:	US
Telephone Number	:	818-501-1455
Fax Number	:	818-528-1013

Provider Business Practice Location Address
First Line	:	4940 VAN NUYS BLVD
Second Line	:	SUITE 200
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1741
Country	:	US
Telephone Number	:	818-501-1455
Fax Number	:	818-528-1013

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	09/27/2012

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Directions to “ DR. JACOB NATHAN RUBIN M.D.” Practice Location

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