Provider Demographics
NPI:1043060668
Name:KOOBATIAN, DUSTIN MARTIN (DO)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:MARTIN
Last Name:KOOBATIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 W MINERAL KING AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6142
Mailing Address - Country:US
Mailing Address - Phone:559-786-6565
Mailing Address - Fax:
Practice Address - Street 1:520 W MINERAL KING AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6142
Practice Address - Country:US
Practice Address - Phone:559-624-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program