MEDICARE: KYLE NATHAN RUBINSTEIN PA-C

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	363A00000X	Physician Assistant	59033	CA

General Provider Information

NPI Number	:	1851980585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE NATHAN RUBINSTEIN PA-C

Provider Business Mailing Address
First Line	:	12712 POPLAR ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2842
Country	:	US
Telephone Number	:	909-964-3207
Fax Number	:

Provider Business Practice Location Address
First Line	:	24060 CAMINO DEL AVION STE A
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-4006
Country	:	US
Telephone Number	:	949-248-8900
Fax Number	:

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

Provider Enumeration Date	:	01/17/2021
Last Update Date	:	09/26/2023

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