Provider Demographics
NPI:1780311175
Name:LUBBEN, ANTONIA (OTR/L)
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:
Last Name:LUBBEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 LAWNDALE PL
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-8106
Mailing Address - Country:US
Mailing Address - Phone:530-276-3511
Mailing Address - Fax:
Practice Address - Street 1:1950 CALLE BARCELONA
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8401
Practice Address - Country:US
Practice Address - Phone:530-276-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478155225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist