Basic Information
| Provider Information | |||||||||
| NPI: | 1790274231 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REUBEN | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MA, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 VILLAGE DR APT 3B | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945131152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152504841 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4849 LONE TREE WAY STE C | ||||||||
| Address2: | |||||||||
| City: | ANTIOCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945318644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254622281 | ||||||||
| FaxNumber: | 9254620439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2018 | ||||||||
| LastUpdateDate: | 05/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.