Provider Demographics
NPI:1104910629
Name:CASABAR, RUBEN SANGALANG (MD)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:SANGALANG
Last Name:CASABAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-3118
Mailing Address - Country:US
Mailing Address - Phone:323-484-9590
Mailing Address - Fax:323-457-9103
Practice Address - Street 1:6021 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-3118
Practice Address - Country:US
Practice Address - Phone:323-484-9590
Practice Address - Fax:323-457-9103
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47793208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A477930Medicaid
CA05D0697594OtherCLIA
CAA47793Medicare PIN
CA05D0697594OtherCLIA