Provider Demographics
NPI:1437888088
Name:LAWRENCE I RUBIN DPM, INC
Entity Type:Organization
Organization Name:LAWRENCE I RUBIN DPM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-323-2887
Mailing Address - Street 1:1045 W REDONDO BEACH BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4276
Mailing Address - Country:US
Mailing Address - Phone:310-323-2887
Mailing Address - Fax:
Practice Address - Street 1:20911 EARL ST STE 290
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4354
Practice Address - Country:US
Practice Address - Phone:310-792-5670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty