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General NPI Number Information
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NPI Number | 1770622375
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Entity Type | Individual
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Provider Name | KATHLEEN MARIE DUBOSE CMT, CIIM,CA
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1901 STANDIFORD AVE SUITE A
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City | MODESTO
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State | CA
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Zip | 95350-0149
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Country | US
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Telephone | 209-324-2060
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 SHADY GLEN CT
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City | MODESTO
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State | CA
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Zip | 95356-8795
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Country | US
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Telephone | 209-544-0549
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Fax | 209-577-3103
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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