Provider Demographics
NPI:1700909256
Name:SUSAN M KUBICA MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SUSAN M KUBICA MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUBICA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-372-1188
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05146ZOtherMEDICARE PROVIDER