Provider Demographics
NPI:1982894572
Name:LAWRENCE I RUBIN DPM, INC
Entity Type:Organization
Organization Name:LAWRENCE I RUBIN DPM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-323-2887
Mailing Address - Street 1:1045 W REDONDO BEACH BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4276
Mailing Address - Country:US
Mailing Address - Phone:310-323-2887
Mailing Address - Fax:310-323-8609
Practice Address - Street 1:1045 W REDONDO BEACH BLVD STE 106
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4276
Practice Address - Country:US
Practice Address - Phone:310-323-2887
Practice Address - Fax:310-323-8609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1602213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17871Medicare PIN