Healthcare Provider Details

I. General information

NPI: 1215266770
Provider Name (Legal Business Name): ERIC KUBAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2009
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 TROUSDALE DR FL 5
BURLINGAME CA
94010-4506
US

IV. Provider business mailing address

577 AIRPORT BLVD STE 300
BURLINGAME CA
94010-2048
US

V. Phone/Fax

Practice location:
  • Phone: 650-652-8787
  • Fax:
Mailing address:
  • Phone: 650-240-8198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA107243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: