Provider Demographics
NPI:1992373815
Name:RUBIN, JOSEPH MARK
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MARK
Last Name:RUBIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 N 163RD ST APT A23
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5699
Mailing Address - Country:US
Mailing Address - Phone:206-403-6797
Mailing Address - Fax:
Practice Address - Street 1:907 N 163RD ST APT A23
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5699
Practice Address - Country:US
Practice Address - Phone:206-403-6797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171R00000X
WAMA4105171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter