Provider Demographics
NPI:1285738567
Name:LAD E RUBAUM MD INC
Entity type:Organization
Organization Name:LAD E RUBAUM MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-901-1535
Mailing Address - Street 1:14860 ROSCOE BLVD
Mailing Address - Street 2:NO 305
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402
Mailing Address - Country:US
Mailing Address - Phone:818-901-1535
Mailing Address - Fax:818-901-0046
Practice Address - Street 1:14860 ROSCOE BLVD
Practice Address - Street 2:NO 305
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402
Practice Address - Country:US
Practice Address - Phone:818-901-1535
Practice Address - Fax:818-901-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A307460Medicare UPIN