Basic Information
| Provider Information | |||||||||
| NPI: | 1861433450 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUBIN | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 686 | ||||||||
| Address2: | ATTENTION: MAGGIE NOLES MS 6160 | ||||||||
| City: | ARTESIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907020686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627414461 | ||||||||
| FaxNumber: | 5627414413 | ||||||||
| Practice Location | |||||||||
| Address1: | 15651 IMPERIAL HWY | ||||||||
| Address2: | SUITE # 105 | ||||||||
| City: | LA MIRADA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906381628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5639437219 | ||||||||
| FaxNumber: | 5629432684 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 05/16/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | G28516 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0G285160 | 01 | BLUE SHIELD ID # | OTHER | 110060909 | 01 | RAILROAD | OTHER | 110060909 | 01 | CA | RAILROAD MEDICARE | OTHER | 014609 | 01 | HEALTH NET ID # | OTHER |