Provider Demographics
NPI:1982723276
Name:J NATHAN RUBIN M.D.
Entity Type:Organization
Organization Name:J NATHAN RUBIN M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAWNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PENUELA
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, MBA
Authorized Official - Phone:818-367-1012
Mailing Address - Street 1:14124 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-8049
Mailing Address - Country:US
Mailing Address - Phone:818-367-1012
Mailing Address - Fax:818-364-2909
Practice Address - Street 1:14124 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-8049
Practice Address - Country:US
Practice Address - Phone:818-367-1012
Practice Address - Fax:818-364-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53079207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G530790Medicaid
CAWG53079NMedicare ID - Type Unspecified
CA00G530790Medicaid