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General NPI Number Information
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NPI Number | 1700957735
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Entity Type | Individual
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Provider Name | MARY P. DUBISZ MD
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/06/2021
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Provider Practice Location Address
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Address Line | SAN MANUEL HEALTH AND WELLNESS CENTER 26569 COMMUNITY CENTER DR
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City | HIGHLAND
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State | CA
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Zip | 92346
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Country | US
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Telephone | 909-651-9960
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Fax | 909-651-9980
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Provider Business Mailing Address
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Address Line | FILE NUMBER 54701
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City | LOS ANGELES
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State | CA
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Zip | 90074-0001
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Country | US
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Telephone | 951-846-2611
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | G66755
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G66755
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License Number State | CA
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