Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E4321 | CA |
Y | 222Z00000X | Podiatrist | E4321 | CA |
NPI | 1013118595 |
---|---|
Provider Name | Dr. Monique Rubin |
First Address | Sylmar, CA 91342-1437 |
Second Address | Sylmar, CA 91342-1437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U91453 | (02) | CA |