Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 MORENA BLVD FL 2
SAN DIEGO CA
92110-3815
US

IV. Provider business mailing address

6160 MISSION GORGE RD STE 108
SAN DIEGO CA
92120-3425
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-8715
  • Fax:
Mailing address:
  • Phone: 619-692-8715
  • Fax: 619-481-5219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: