Provider Demographics
NPI:1093569162
Name:RUBLAITUS, JOHN MICHAEL III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:RUBLAITUS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13342 INDIAN BOW CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-8948
Mailing Address - Country:US
Mailing Address - Phone:415-462-1536
Mailing Address - Fax:415-279-3424
Practice Address - Street 1:13342 INDIAN BOW CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-8948
Practice Address - Country:US
Practice Address - Phone:415-462-1536
Practice Address - Fax:415-279-3424
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program