Healthcare Provider Details

I. General information

NPI: 1235092016
Provider Name (Legal Business Name): MAKSIM KUBARKA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4132 KATELLA AVE STE 102
LOS ALAMITOS CA
90720-3491
US

IV. Provider business mailing address

4457 CASA GRANDE CIR APT 448
CYPRESS CA
90630-2578
US

V. Phone/Fax

Practice location:
  • Phone: 562-446-7089
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: