Provider Demographics
NPI:1093937708
Name:PUNZALAN, RUBIO REYES (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBIO
Middle Name:REYES
Last Name:PUNZALAN
Suffix:
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 1:1241 ENCINO DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1009
Mailing Address - Country:US
Mailing Address - Phone:626-201-9893
Mailing Address - Fax:
Practice Address - Street 1:1241 ENCINO DR
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108
Practice Address - Country:US
Practice Address - Phone:626-201-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66411207ZP0102X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology