Provider Demographics
NPI:1790050334
Name:VAN NUYS ORTHOPEDICS
Entity Type:Organization
Organization Name:VAN NUYS ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBANENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-863-0022
Mailing Address - Street 1:FILE 1403
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91199-1403
Mailing Address - Country:US
Mailing Address - Phone:949-863-0022
Mailing Address - Fax:
Practice Address - Street 1:14600 SHERMAN WAY # 100A
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2283
Practice Address - Country:US
Practice Address - Phone:949-863-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty