Healthcare Provider Details

I. General information

NPI: 1043924764
Provider Name (Legal Business Name): COBY DULITZKI LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 JACKSON DR
SAN DIEGO CA
92119-3306
US

IV. Provider business mailing address

6401 JACKSON DR
SAN DIEGO CA
92119-3306
US

V. Phone/Fax

Practice location:
  • Phone: 650-374-8219
  • Fax:
Mailing address:
  • Phone: 650-374-8219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number76801
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: