Provider Demographics
NPI:1679678916
Name:LIN, RUBIN C (DO)
Entity Type:Individual
Prefix:
First Name:RUBIN
Middle Name:C
Last Name:LIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16854 IVY AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-1504
Mailing Address - Country:US
Mailing Address - Phone:909-791-1000
Mailing Address - Fax:
Practice Address - Street 1:16854 IVY AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-1504
Practice Address - Country:US
Practice Address - Phone:909-791-1000
Practice Address - Fax:909-389-1316
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine