Provider Demographics
NPI:1861682940
Name:BAKERYWALA, RUBINA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBINA
Middle Name:Y
Last Name:BAKERYWALA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:807 CHILDRENS WAY
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8426
Mailing Address - Country:US
Mailing Address - Phone:302-697-3694
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:807 CHILDRENS WAY
Practice Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8426
Practice Address - Country:US
Practice Address - Phone:302-697-3694
Practice Address - Fax:302-651-4945
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2016-07-06
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1095782084N0402X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003504400Medicaid