Provider Demographics
NPI:1467568105
Name:RUBENSTEIN, RONALD L (M D)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:RUBENSTEIN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13847 E 14TH ST
Mailing Address - Street 2:#200
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2632
Mailing Address - Country:US
Mailing Address - Phone:510-352-5470
Mailing Address - Fax:510-352-3154
Practice Address - Street 1:13847 E 14TH ST
Practice Address - Street 2:#200
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2632
Practice Address - Country:US
Practice Address - Phone:510-352-5470
Practice Address - Fax:510-352-3154
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG33407207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G334070Medicaid
CA040016292OtherRAILROAD MEDICARE NUMBER
CAA45537Medicare UPIN
CA00G334070Medicare PIN