Provider Demographics
NPI:1639119852
Name:CUBEIRO, MARC GREGORY (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:GREGORY
Last Name:CUBEIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16100 SAND CANYON AVE
Mailing Address - Street 2:170
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3716
Mailing Address - Country:US
Mailing Address - Phone:949-387-9700
Mailing Address - Fax:949-387-9800
Practice Address - Street 1:16100 SAND CANYON AVE
Practice Address - Street 2:170
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-387-9700
Practice Address - Fax:949-387-3800
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2012-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG40805207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G408050Medicaid
CAG40805Medicare PIN
CAWG40805AMedicare PIN
A92207Medicare UPIN