Provider Demographics
NPI:1851980585
Name:RUBINSTEIN, KYLE NATHAN (PA-C)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:NATHAN
Last Name:RUBINSTEIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12712 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2842
Mailing Address - Country:US
Mailing Address - Phone:909-964-3207
Mailing Address - Fax:
Practice Address - Street 1:24060 CAMINO DEL AVION STE A
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-4006
Practice Address - Country:US
Practice Address - Phone:949-248-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-17
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59033363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant