Provider Demographics
NPI:1790762763
Name:RUBIN, OLEG F (MD)
Entity Type:Individual
Prefix:
First Name:OLEG
Middle Name:F
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1261 TRAVIS BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4897
Mailing Address - Country:US
Mailing Address - Phone:707-426-5407
Mailing Address - Fax:707-426-6376
Practice Address - Street 1:1261 TRAVIS BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4897
Practice Address - Country:US
Practice Address - Phone:707-426-5407
Practice Address - Fax:707-426-6376
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA81462207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A814620Medicaid
CAZZZ27071ZOtherMEDICARE CA NORTH GROUP
CA00A814620Medicaid
CA00A814620Medicare PIN
CAI33312Medicare UPIN