Provider Demographics
NPI:1154532745
Name:RUBENSTEIN, BRUCE DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DAVID
Last Name:RUBENSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19231 VICTORY BLVD STE 352
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6352
Mailing Address - Country:US
Mailing Address - Phone:818-705-2856
Mailing Address - Fax:818-705-0576
Practice Address - Street 1:19231 VICTORY BLVD STE 352
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6352
Practice Address - Country:US
Practice Address - Phone:818-705-2856
Practice Address - Fax:818-705-0576
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3282103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical