Provider Demographics
NPI:1710907696
Name:RUBIN, ALAN LEE (M D)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:LEE
Last Name:RUBIN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 POST ST
Mailing Address - Street 2:SUITE 544
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1401
Mailing Address - Country:US
Mailing Address - Phone:415-391-5667
Mailing Address - Fax:415-391-5668
Practice Address - Street 1:490 POST ST
Practice Address - Street 2:SUITE 544
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1401
Practice Address - Country:US
Practice Address - Phone:415-391-5667
Practice Address - Fax:415-391-5668
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15279174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G152790Medicaid
CA00G152790Medicare ID - Type Unspecified
CA00G152790Medicaid