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General NPI Number Information
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NPI Number | 1316340425
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Entity Type | Organization
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Legal Business Name | E KULUBYA MD,P.C
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 3220 THATCHER AVE
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5556
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Country | US
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Telephone | 714-234-7485
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Fax |
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Provider Business Mailing Address
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Address Line | 3220 THATCHER AVE
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5556
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Country | US
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Telephone | 714-234-7485
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWIN SAMUEL KULUBYA
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Credential | M.D
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Telephone | 714-234-7485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | G54189
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License Number State | CA
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