Provider Demographics
NPI:1275372062
Name:RUBIN, LAQUANDA
Entity type:Individual
Prefix:
First Name:LAQUANDA
Middle Name:
Last Name:RUBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16455 NELSON PARK DR APT 306B
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-5866
Mailing Address - Country:US
Mailing Address - Phone:520-732-6217
Mailing Address - Fax:
Practice Address - Street 1:425 W COLONIAL DR STE 303
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6863
Practice Address - Country:US
Practice Address - Phone:352-901-4009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management