Provider Demographics
NPI:1558537639
Name:RUBIN, NIKKI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NIKKI
Middle Name:
Last Name:RUBIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 W OLYMPIC BLVD STE 460
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1562
Mailing Address - Country:US
Mailing Address - Phone:310-933-4198
Mailing Address - Fax:310-933-4198
Practice Address - Street 1:11500 W OLYMPIC BLVD STE 460
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1562
Practice Address - Country:US
Practice Address - Phone:310-933-4198
Practice Address - Fax:310-933-4198
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019595103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical