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General NPI Number Information
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NPI Number | 1881014702
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Entity Type | Individual
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Provider Name | MARILYNN KIRCHUBEL P.A.
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Gender | Female
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Dates
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Enumeration Date | 04/17/2014
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 2160 W GRANT LINE RD STE 230
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City | TRACY
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State | CA
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Zip | 95377-7334
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Country | US
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Telephone | 209-832-8700
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Fax | 209-832-2210
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Provider Business Mailing Address
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Address Line | 2160 W GRANT LINE RD STE 230
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City | TRACY
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State | CA
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Zip | 95377-7334
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Country | US
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Telephone | 209-832-8700
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Fax | 209-832-2210
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA 11603
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License Number State | CA
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