Provider Demographics
NPI:1629212071
Name:COBABE, MAREN KUSSLER (LAC)
Entity Type:Individual
Prefix:
First Name:MAREN
Middle Name:KUSSLER
Last Name:COBABE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:295 E 3RD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3141
Mailing Address - Country:US
Mailing Address - Phone:562-435-7699
Mailing Address - Fax:562-435-7641
Practice Address - Street 1:295 E 3RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-3141
Practice Address - Country:US
Practice Address - Phone:562-435-7699
Practice Address - Fax:562-435-7641
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC6046171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist