Provider Demographics
NPI:1144385253
Name:KUBO, PATRICIA L (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:KUBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7156
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0156
Mailing Address - Country:US
Mailing Address - Phone:209-467-6866
Mailing Address - Fax:
Practice Address - Street 1:1665 DOMINICAN WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1528
Practice Address - Country:US
Practice Address - Phone:831-476-6943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27119207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G271190Medicaid
CA00G271190Medicare ID - Type Unspecified
CAA43230Medicare UPIN