Provider Demographics
NPI:1508859240
Name:KUBENA, KASSIA LOUEVA (MD)
Entity Type:Individual
Prefix:DR
First Name:KASSIA
Middle Name:LOUEVA
Last Name:KUBENA
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 1:5255 PRUE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1335
Mailing Address - Country:US
Mailing Address - Phone:210-877-9966
Mailing Address - Fax:210-877-1162
Practice Address - Street 1:5255 PRUE RD
Practice Address - Street 2:STE. 105
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1335
Practice Address - Country:US
Practice Address - Phone:210-877-9966
Practice Address - Fax:210-877-1162
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6067208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047539403Medicaid
TX00623XMedicare ID - Type UnspecifiedMEDICARE INDIVID. NUMBER
TX047539403Medicaid