1053420273 NPI number — MS. SUSAN MARIE RUBINSTEIN MFCC

Table of content: JACKYLIN CAPARAS M.D. (NPI 1881991834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053420273 NPI number — MS. SUSAN MARIE RUBINSTEIN MFCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBINSTEIN
Provider First Name:
SUSAN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUCHOBOKY
Provider Other First Name:
SUSAN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053420273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2701 COTTAGE WAY
Provider Second Line Business Mailing Address:
#35
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-485-2582
Provider Business Mailing Address Fax Number:
916-388-0688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 COTTAGE WAY
Provider Second Line Business Practice Location Address:
#35
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-485-2582
Provider Business Practice Location Address Fax Number:
916-388-0688
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFCC9506 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9506 . This is a "MFCC BD BEHAVIORAL SCIENC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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