MEDICARE: PATRICIA L KUBO MD

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	207L00000X	Anesthesiology Physician	G27119	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144385253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA L KUBO MD

Provider Business Mailing Address
First Line	:	PO BOX 7156
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95267-0156
Country	:	US
Telephone Number	:	209-467-6866
Fax Number	:

Provider Business Practice Location Address
First Line	:	1665 DOMINICAN WAY
Second Line	:	SUITE 120
City	:	SANTA CRUZ
State	:	CA
Zip	:	95065-1528
Country	:	US
Telephone Number	:	831-476-6943
Fax Number	:

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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