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NPI Code Detail

MEDICARE: EVERLYN KUBAO

MEDICARE: EVERLYN KUBAO
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
1183500000XPharmacist68013CA

General Provider Information

NPI Number : 1477986594
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVERLYN KUBAO
Provider Business Mailing Address
First Line : 3335 APPLETON ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90039-1701
Country : US
Telephone Number : 323-283-5794
Fax Number :
Provider Business Practice Location Address
First Line : 1625 W SUNSET BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-4226
Country : US
Telephone Number : 213-482-9286
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2013
Last Update Date : 08/12/2013

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Directions to “ EVERLYN KUBAO ” Practice Location

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