Healthcare Provider Details

I. General information

NPI: 1528278744
Provider Name (Legal Business Name): ALVIN R. KUBAT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: AL KUBAT PH.D.

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NE 7TH ST SUITE C
GRANTS PASS OR
97526-1451
US

IV. Provider business mailing address

1201 NE 7TH STREET SUITE C
GRANTS PASS OR
97526
US

V. Phone/Fax

Practice location:
  • Phone: 541-450-5676
  • Fax:
Mailing address:
  • Phone: 541-450-5676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY6938
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1979
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: