Provider Demographics
NPI:1750675864
Name:CUBILLO, EFRAIN ISRAEL IV (MD)
Entity Type:Individual
Prefix:DR
First Name:EFRAIN
Middle Name:ISRAEL
Last Name:CUBILLO
Suffix:IV
Gender:M
Credentials:MD
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Mailing Address - Street 1:4582 N 1ST AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-8607
Mailing Address - Country:US
Mailing Address - Phone:520-318-6035
Mailing Address - Fax:520-765-9952
Practice Address - Street 1:4582 N 1ST AVE STE 170
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-8607
Practice Address - Country:US
Practice Address - Phone:520-318-6035
Practice Address - Fax:520-318-6035
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2016-06-15
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Provider Licenses
StateLicense IDTaxonomies
AZ46229207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZPENDINGOtherPENDING