Provider Demographics
NPI:1912718701
Name:KUBOTA, REIKO (LAC)
Entity type:Individual
Prefix:MS
First Name:REIKO
Middle Name:
Last Name:KUBOTA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 ABAJO DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-2311
Mailing Address - Country:US
Mailing Address - Phone:214-725-3005
Mailing Address - Fax:
Practice Address - Street 1:1880 ABAJO DR
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-2311
Practice Address - Country:US
Practice Address - Phone:214-725-3005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18569171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist