Provider Demographics
NPI:1356453666
Name:RUBIN, MARK G (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:153 S LASKY DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1721
Mailing Address - Country:US
Mailing Address - Phone:310-556-0119
Mailing Address - Fax:310-556-0111
Practice Address - Street 1:153 S LASKY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1721
Practice Address - Country:US
Practice Address - Phone:310-556-0119
Practice Address - Fax:310-556-0111
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG54534174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist