Provider Demographics
NPI:1467496091
Name:REES, ATSUKO EUBANK (MD)
Entity Type:Individual
Prefix:DR
First Name:ATSUKO
Middle Name:EUBANK
Last Name:REES
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 1:1890 DIABLO DR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-4762
Mailing Address - Country:US
Mailing Address - Phone:805-441-0545
Mailing Address - Fax:
Practice Address - Street 1:4251 S HIGUERA ST
Practice Address - Street 2:SUITE 401
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7700
Practice Address - Country:US
Practice Address - Phone:805-540-6010
Practice Address - Fax:805-540-6011
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C417451Medicaid
CA00C417451Medicaid