Provider Demographics
NPI:1154459998
Name:RUBASHKIN, NICHOLAS A (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:RUBASHKIN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60000
Mailing Address - Street 2:FILE 74175
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160-0001
Mailing Address - Country:US
Mailing Address - Phone:415-641-2177
Mailing Address - Fax:415-641-2190
Practice Address - Street 1:1580 VALENCIA ST
Practice Address - Street 2:STE 508
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4423
Practice Address - Country:US
Practice Address - Phone:415-641-2140
Practice Address - Fax:415-641-2150
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2010-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA94707207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA94707OtherCALIFORNIA STATE MEDICAL LICENSE