Provider Demographics
NPI:1508895095
Name:RUBENSTEIN, ELYSE JOAN (MD)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:JOAN
Last Name:RUBENSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1804
Mailing Address - Country:US
Mailing Address - Phone:310-256-2425
Mailing Address - Fax:310-395-3218
Practice Address - Street 1:1328 16TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1804
Practice Address - Country:US
Practice Address - Phone:310-256-2425
Practice Address - Fax:310-395-3218
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80939207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A809390Medicaid
CA00A809390Medicaid
CAWA80939AMedicare ID - Type UnspecifiedPPIN