Provider Demographics
NPI:1982654307
Name:WRUBEL, KAREN LYNN (DPM)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LYNN
Last Name:WRUBEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13624 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5818
Mailing Address - Country:US
Mailing Address - Phone:310-675-0900
Mailing Address - Fax:310-675-0904
Practice Address - Street 1:13624 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5818
Practice Address - Country:US
Practice Address - Phone:310-675-0900
Practice Address - Fax:310-675-0904
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3328213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE22380Medicaid
CAGRE001780Medicaid
CAE22380Medicaid
CAGRE001780Medicaid