Provider Demographics
NPI:1922501972
Name:KUBRIN, MARA SONYA (MS, SLP)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:SONYA
Last Name:KUBRIN
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ANZAVISTA AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3830
Mailing Address - Country:US
Mailing Address - Phone:415-694-3813
Mailing Address - Fax:
Practice Address - Street 1:40 ANZAVISTA AVE APT 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3830
Practice Address - Country:US
Practice Address - Phone:415-694-3813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26366235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist