MEDICARE: COBY DULITZKI LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach
2	225700000X	Massage Therapist	76801	CA

General Provider Information

NPI Number	:	1043924764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COBY DULITZKI LMT

Provider Business Mailing Address
First Line	:	6401 JACKSON DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-3306
Country	:	US
Telephone Number	:	650-374-8219
Fax Number	:

Provider Business Practice Location Address
First Line	:	6401 JACKSON DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-3306
Country	:	US
Telephone Number	:	650-374-8219
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	01/09/2023

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Directions to “ COBY DULITZKI LMT” Practice Location

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