Provider Demographics
NPI:1861433450
Name:RUBIN, STANLEY W (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:W
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:ATTENTION: MAGGIE NOLES MS 6160
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-0686
Mailing Address - Country:US
Mailing Address - Phone:562-741-4461
Mailing Address - Fax:562-741-4413
Practice Address - Street 1:15651 IMPERIAL HWY
Practice Address - Street 2:SUITE # 105
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1628
Practice Address - Country:US
Practice Address - Phone:563-943-7219
Practice Address - Fax:562-943-2684
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2009-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28516207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0G285160OtherBLUE SHIELD ID #
110060909OtherRAILROAD
CA110060909OtherRAILROAD MEDICARE
014609OtherHEALTH NET ID #
0G285160OtherBLUE SHIELD ID #
W43762Medicare UPIN
110060909OtherRAILROAD
CA110060909OtherRAILROAD MEDICARE