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General NPI Number Information
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NPI Number | 1164424180
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Entity Type | Individual
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Provider Name | MARILYN MITTLESTAT LUEBBERT D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | NAVAL HOSPITAL, CAMP PENDLETON BLDG H100, SANTA MARGARITA RD ATTN: CODE CS-PA
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City | CAMP PENDELTON
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State | CA
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Zip | 92055
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Country | US
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Telephone | 760-725-1267
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Fax |
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Provider Business Mailing Address
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Address Line | 5702 W CIRCLE Z ST
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City | TUCSON
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State | AZ
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Zip | 85713-4417
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Country | US
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Telephone | 520-780-1285
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 21742
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License Number State | GA
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