Provider Demographics
NPI:1003907387
Name:RUBAUM, LAD E (MD)
Entity Type:Individual
Prefix:
First Name:LAD
Middle Name:E
Last Name:RUBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14860 ROSCOE BLVD
Mailing Address - Street 2:NO 305
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402
Mailing Address - Country:US
Mailing Address - Phone:818-901-1535
Mailing Address - Fax:818-901-0046
Practice Address - Street 1:14860 ROSCOE BLVD
Practice Address - Street 2:NO 305
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402
Practice Address - Country:US
Practice Address - Phone:818-901-1535
Practice Address - Fax:818-901-0046
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00A307460207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A307461Medicaid
CAA26215Medicare UPIN
CAA30746AMedicare PIN