Provider Demographics
NPI:1346218062
Name:LUBANSKI, KATHLEEN D (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:D
Last Name:LUBANSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68860 PEREZ RD
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-7248
Mailing Address - Country:US
Mailing Address - Phone:760-328-4499
Mailing Address - Fax:760-328-1050
Practice Address - Street 1:68860 PEREZ RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-7249
Practice Address - Country:US
Practice Address - Phone:760-328-4499
Practice Address - Fax:760-328-1050
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4207363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23522ZMedicare ID - Type Unspecified
CAP60913Medicare UPIN