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General NPI Number Information
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NPI Number | 1073179784
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Entity Type | Individual
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Provider Name | DR. BROOKE KUBAT
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Gender | Female
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Dates
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Enumeration Date | 05/17/2019
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 2 MEDICAL PLAZA DR STE 205
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City | ROSEVILLE
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State | CA
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Zip | 95661-3044
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Country | US
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Telephone | 916-773-8711
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Fax | 916-503-7693
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Provider Business Mailing Address
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Address Line | PO BOX 255228
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City | SACRAMENTO
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State | CA
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Zip | 95865-5228
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | R-11483
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | A198619
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License Number State | CA
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