Provider Demographics
NPI:1316058423
Name:RUBANOWITZ, DANIEL ERIC (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ERIC
Last Name:RUBANOWITZ
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 1:1211 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1522
Mailing Address - Country:US
Mailing Address - Phone:530-243-8403
Mailing Address - Fax:530-243-7392
Practice Address - Street 1:1211 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1522
Practice Address - Country:US
Practice Address - Phone:530-243-8403
Practice Address - Fax:530-243-7392
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10196103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL101960Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID