MEDICARE: DR. EFRAIN ISRAEL CUBILLO IV 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	46229	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZPENDING	OTHER	AZ	PENDING

General Provider Information

NPI Number	:	1750675864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EFRAIN ISRAEL CUBILLO IV MD

Provider Business Mailing Address
First Line	:	4582 N 1ST AVE STE 170
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-8607
Country	:	US
Telephone Number	:	520-318-6035
Fax Number	:	520-765-9952

Provider Business Practice Location Address
First Line	:	4582 N 1ST AVE STE 170
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-8607
Country	:	US
Telephone Number	:	520-318-6035
Fax Number	:	520-318-6035

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

Provider Enumeration Date	:	06/06/2011
Last Update Date	:	06/15/2016

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