Provider Demographics
NPI:1427078690
Name:REUBEN, DAVID BART (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BART
Last Name:REUBEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5767 W. CENTURY BLVD.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5655
Mailing Address - Country:US
Mailing Address - Phone:310-301-8714
Mailing Address - Fax:310-301-8712
Practice Address - Street 1:1245 16TH ST STE 204
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1240
Practice Address - Country:US
Practice Address - Phone:310-319-4371
Practice Address - Fax:310-319-4141
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66427207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G664270Medicaid
CAWG66427AMedicare PIN
CA00G664270Medicaid