Provider Demographics
NPI:1922646769
Name:RUBINSTEIN, MICHELLE (RD, CLC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:RUBINSTEIN
Suffix:
Gender:F
Credentials:RD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 VICAR ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2728
Mailing Address - Country:US
Mailing Address - Phone:847-778-9978
Mailing Address - Fax:
Practice Address - Street 1:9800 VICAR ST UNIT 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-2728
Practice Address - Country:US
Practice Address - Phone:847-778-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320068174N00000X
NY86111957133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN