Provider Demographics
NPI:1083299317
Name:LUBKE, ANNA KRISTINA (CMT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KRISTINA
Last Name:LUBKE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:TWIST LUBKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:323 RODGERS ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3070
Mailing Address - Country:US
Mailing Address - Phone:707-872-7898
Mailing Address - Fax:
Practice Address - Street 1:323 RODGERS ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3070
Practice Address - Country:US
Practice Address - Phone:707-872-7898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01184408376K00000X
CA79615225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No376K00000XNursing Service Related ProvidersNurse's Aide