Provider Demographics
NPI:1801007968
Name:RICHARD A SHUBIN, M.D., INC.
Entity Type:Organization
Organization Name:RICHARD A SHUBIN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-332-7090
Mailing Address - Street 1:1015 NORTH FIRST AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7401
Mailing Address - Country:US
Mailing Address - Phone:626-332-7090
Mailing Address - Fax:800-924-7301
Practice Address - Street 1:1015 NORTH FIRST AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-7401
Practice Address - Country:US
Practice Address - Phone:626-332-7090
Practice Address - Fax:800-924-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50827174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHG50827AOtherBLUE CROSS
CAHG50827OtherBLUE SHIELD
CA00G508270Medicaid
CA130003203Medicare ID - Type UnspecifiedRAILROAD MEDICARE
CAHG50827AOtherBLUE CROSS
CAE02703Medicare UPIN
CA00G508270Medicaid