Provider Demographics
NPI:1013012368
Name:RUBIN, LAWRENCE IRA (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:IRA
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 W REDONDO BEACH BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4128
Mailing Address - Country:US
Mailing Address - Phone:310-323-2887
Mailing Address - Fax:310-323-8609
Practice Address - Street 1:1045 W REDONDO BCH BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247
Practice Address - Country:US
Practice Address - Phone:310-323-2887
Practice Address - Fax:310-323-8609
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1602213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4800826706OtherRAILROAD
CA00E16020Medicaid
CA0861760001Medicare NSC
CAV00413Medicare UPIN
CA00E16020Medicaid
CAT11004Medicare UPIN
CAWE1602BMedicare PIN