Healthcare Provider Details

I. General information

NPI: 1174430177
Provider Name (Legal Business Name): EMIKO THERESA-BETH KUBOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 MARKET AVE W
MADERA CA
93636-8171
US

IV. Provider business mailing address

37479 AVENUE 12
MADERA CA
93636-8726
US

V. Phone/Fax

Practice location:
  • Phone: 559-645-3530
  • Fax:
Mailing address:
  • Phone: 559-645-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number38158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: