MEDICARE: LISA V. RUBENSTEIN 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	G035506	CA

General Provider Information

NPI Number	:	1477656643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA V. RUBENSTEIN M.D.

Provider Business Mailing Address
First Line	:	15501 AZZURE CT
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-1505
Country	:	US
Telephone Number	:	310-472-3235
Fax Number	:	310-472-2538

Provider Business Practice Location Address
First Line	:	16111 PLUMMER ST
Second Line	:	VA GREATER LOS ANGELES (152)
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-2036
Country	:	US
Telephone Number	:	818-895-9449
Fax Number	:	818-895-5838

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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