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General NPI Number Information
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NPI Number | 1265192637
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Entity Type | Individual
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Provider Name | KYLE LUBEN PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/27/2021
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 6905 HARRIS AVE, MCBH
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City | FPO
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State | AP
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Zip | 96734
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Country | US
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Telephone | 808-257-3365
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Fax |
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Provider Business Mailing Address
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Address Line | 141 MAYFAIR ST
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City | OCEANSIDE
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State | CA
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Zip | 92058-1447
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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