Provider Demographics
NPI:1710263595
Name:RABIN, BRETT EVAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:EVAN
Last Name:RABIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:BRETT
Other - Middle Name:EVAN
Other - Last Name:RABIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:4954 DEL MONTE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3209
Mailing Address - Country:US
Mailing Address - Phone:619-764-9681
Mailing Address - Fax:
Practice Address - Street 1:4954 DEL MONTE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-3209
Practice Address - Country:US
Practice Address - Phone:619-764-9681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14252171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist