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General NPI Number Information
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NPI Number | 1609833367
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Entity Type | Organization
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Legal Business Name | DR CARRIE R KUBOTA & ASSOCIATES
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1197 D E LOS ANGELES AVE
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City | SIMI VALLEY
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State | CA
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Zip | 93065
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Country | US
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Telephone | 805-577-9177
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Fax | 805-527-8220
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Provider Business Mailing Address
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Address Line | 1197 D E LOS ANGELES AVE
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City | SIMI VALLEY
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State | CA
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Zip | 93065
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Country | US
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Telephone | 805-577-9177
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Fax | 805-527-8220
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Authorized Official
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Title or Position | OWNER DR
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Name | DR. CARRIE R KUBOTA
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Credential | OD
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Telephone | 805-577-9177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT9907TPA
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License Number State | CA
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