1336279405 NPI number — DAVID M RUBIN,PH.D.,P.C.

Table of content: (NPI 1336279405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336279405 NPI number — DAVID M RUBIN,PH.D.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID M RUBIN,PH.D.,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1336279405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13776
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85732-3776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-529-8190
Provider Business Mailing Address Fax Number:
520-529-2557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5680 N CAMINO REAL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85718-4212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-529-8190
Provider Business Practice Location Address Fax Number:
520-529-2557
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RUBIN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
520-529-8190

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1115 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com