Provider Demographics
NPI:1912319609
Name:RUBINSTEIN, TATE (DOM, DIPL OM,)
Entity Type:Individual
Prefix:
First Name:TATE
Middle Name:
Last Name:RUBINSTEIN
Suffix:
Gender:M
Credentials:DOM, DIPL OM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 S CAMINO DEL PUEBLO
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-5791
Mailing Address - Country:US
Mailing Address - Phone:505-867-5911
Mailing Address - Fax:
Practice Address - Street 1:438 S. CAMINO DEL PUEBLO
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004
Practice Address - Country:US
Practice Address - Phone:505-867-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1137171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist