Active NPI
Alan Leslie Dubin, M.D.
- Psychiatry Physician
- Petaluma, CA
National Provider Identifier
1386778348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- C36994
- Practice address
- 14 Keller St
Petaluma, CA 94952-2939 - Phone
- (707) 769-1220
- Fax
- (707) 769-1220
- NPI assigned
- Mar 14, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | C36994 | CA | Primary |
Addresses
Primary practice location
14 Keller St
Petaluma, CA 94952-2939
Mailing address
14 Keller St
Petaluma, CA 94952-2939
Phone (707) 769-1220
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 18, 2017 through Jun 18, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36994 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471824000000",
"number": "1386778348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 KELLER ST",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949522939",
"telephone_number": "707-769-1220",
"fax_number": "707-769-1220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14 KELLER ST",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949522939",
"telephone_number": "707-769-1220",
"fax_number": "707-769-1220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUBIN",
"first_name": "ALAN",
"middle_name": "LESLIE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-14",
"last_updated": "2016-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "C36994",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.