Provider Demographics
NPI:1700957735
Name:DUBISZ, MARY P (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:DUBISZ
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:FILE NUMBER 54701
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0001
Mailing Address - Country:US
Mailing Address - Phone:951-846-2611
Mailing Address - Fax:
Practice Address - Street 1:SAN MANUEL HEALTH AND WELLNESS CENTER
Practice Address - Street 2:26569 COMMUNITY CENTER DR
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346
Practice Address - Country:US
Practice Address - Phone:909-651-9960
Practice Address - Fax:909-651-9980
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG66755207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine