Healthcare Provider Details

I. General information

NPI: 1598030678
Provider Name (Legal Business Name): BOB KIGAI MUBALLE MA, AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 ALTA RD
SAN DIEGO CA
92179-0001
US

IV. Provider business mailing address

480 ALTA RD
SAN DIEGO CA
92179-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-661-6500
  • Fax:
Mailing address:
  • Phone: 619-661-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162261
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number162261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: