Provider Demographics
NPI:1245432327
Name:SONNY RUBIN, M.D., PA, INC.
Entity Type:Organization
Organization Name:SONNY RUBIN, M.D., PA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SONNY
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-560-1580
Mailing Address - Street 1:PO BOX 1809
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92856-0809
Mailing Address - Country:US
Mailing Address - Phone:714-560-1580
Mailing Address - Fax:714-560-1585
Practice Address - Street 1:2557 PACIFIC COAST HWY
Practice Address - Street 2:A
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-7035
Practice Address - Country:US
Practice Address - Phone:310-626-8037
Practice Address - Fax:310-626-8038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76500207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I08623Medicare UPIN