Provider Demographics
NPI:1659772606
Name:SONNY RUBIN, M.D. INC
Entity Type:Organization
Organization Name:SONNY RUBIN, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-933-7012
Mailing Address - Street 1:455 OLD NEWPORT BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4241
Mailing Address - Country:US
Mailing Address - Phone:949-933-7012
Mailing Address - Fax:949-387-3380
Practice Address - Street 1:455 OLD NEWPORT BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4241
Practice Address - Country:US
Practice Address - Phone:949-933-7012
Practice Address - Fax:949-387-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76500208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA76500OtherLICENSE