Provider Demographics
NPI:1659915759
Name:LAWRENCE R. ROUBEN MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LAWRENCE R. ROUBEN MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:ROUBEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-432-3694
Mailing Address - Street 1:6011 MIDMAR CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-8197
Mailing Address - Country:US
Mailing Address - Phone:661-432-3694
Mailing Address - Fax:
Practice Address - Street 1:28400 MCCALL BLVD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92585-9658
Practice Address - Country:US
Practice Address - Phone:661-432-3694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty