Provider Demographics
NPI:1245321876
Name:KUBICA, SUSAN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:KUBICA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 8TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3664
Mailing Address - Country:US
Mailing Address - Phone:831-372-1188
Mailing Address - Fax:831-372-1181
Practice Address - Street 1:1000 8TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3664
Practice Address - Country:US
Practice Address - Phone:831-372-1188
Practice Address - Fax:831-372-1181
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51385207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A513850Medicaid
F57359Medicare UPIN
CA00A513850Medicaid