Provider Demographics
NPI:1740752062
Name:KUBAI, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KUBAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27699 JEFFERSON AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2697
Mailing Address - Country:US
Mailing Address - Phone:855-501-1004
Mailing Address - Fax:951-244-6014
Practice Address - Street 1:27699 JEFFERSON AVE STE 111
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2697
Practice Address - Country:US
Practice Address - Phone:855-501-1004
Practice Address - Fax:951-244-6014
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95101149163W00000X
AZ263260363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse