Healthcare Provider Details

I. General information

NPI: 1598471492
Provider Name (Legal Business Name): GLORIA KUBUANU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N 5TH ST
ALBEMARLE NC
28001-3420
US

IV. Provider business mailing address

1000 N 5TH ST
ALBEMARLE NC
28001-3420
US

V. Phone/Fax

Practice location:
  • Phone: 980-581-2448
  • Fax: 828-499-7001
Mailing address:
  • Phone: 980-581-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-12936
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0010-12936
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: