Provider Demographics
NPI:1437548716
Name:RUBIN, LESLIE FAY (CRNA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:FAY
Last Name:RUBIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 J ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2131
Mailing Address - Country:US
Mailing Address - Phone:707-217-7166
Mailing Address - Fax:
Practice Address - Street 1:4150 V STREET, PSSB STE 1200
Practice Address - Street 2:UCDMC DEPT OF ANESTHESIOLOGY & PAIN MEDICINE
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-5028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA776659 RN367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95000252OtherRN LICENSE