Provider Demographics
NPI:1336262906
Name:J. NATHAN RUBIN, M.D., F.A.C.C., INC.
Entity Type:Organization
Organization Name:J. NATHAN RUBIN, M.D., F.A.C.C., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-501-1455
Mailing Address - Street 1:4940 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1741
Mailing Address - Country:US
Mailing Address - Phone:818-501-1455
Mailing Address - Fax:818-528-1013
Practice Address - Street 1:4940 VAN NUYS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1741
Practice Address - Country:US
Practice Address - Phone:818-501-1455
Practice Address - Fax:818-528-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53079207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G530790Medicaid
CAW20900Medicare PIN