Healthcare Provider Details

I. General information

NPI: 1346162997
Provider Name (Legal Business Name): WILLIAM LUBKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10319 FIRMONA AVE
INGLEWOOD CA
90304-1419
US

IV. Provider business mailing address

11347 NEBRASKA AVE APT 106
LOS ANGELES CA
90025-6712
US

V. Phone/Fax

Practice location:
  • Phone: 408-307-5751
  • Fax:
Mailing address:
  • Phone: 408-307-5751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number38289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: