1437548716 NPI number — LESLIE FAY RUBIN CRNA

Table of content: LESLIE FAY RUBIN CRNA (NPI 1437548716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437548716 NPI number — LESLIE FAY RUBIN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBIN
Provider First Name:
LESLIE
Provider Middle Name:
FAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437548716
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 J ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVIS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95616-2131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-217-7166
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4150 V STREET, PSSB STE 1200
Provider Second Line Business Practice Location Address:
UCDMC DEPT OF ANESTHESIOLOGY & PAIN MEDICINE
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-1460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-5028
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2015

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: 367500000X , with the licence number:  776659 RN , 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: 95000252 . This is a "RN LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".