Healthcare Provider Details

I. General information

NPI: 1013715291
Provider Name (Legal Business Name): PAUL KOBULNICKY DC, CADCII
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 WINDSOR RD
OCEANSIDE CA
92056-4945
US

IV. Provider business mailing address

3515 WINDSOR RD
OCEANSIDE CA
92056-4945
US

V. Phone/Fax

Practice location:
  • Phone: 760-845-4502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA5180710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: