Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC18156 | CA |
Y | 213ER0200X | Radiology | DC18156 | CA |
NPI | 1720204233 |
---|---|
Provider Name | Dr. David Russell Reuben |
First Address | Canyon Country, CA 91387-2155 |
Second Address | Canyon Country, CA 91387-2155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 17/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11 | CHIROPRACTIC (01) | CA |