Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 00A307460 | CA |
NPI | 1003907387 |
---|---|
Provider Name | Lad E Rubaum |
First Address | Panorama City, CA 91402 |
Second Address | Panorama City, CA 91402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 25/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A307461 | (05) | CA |
A26215 | (02) | CA |