Provider Demographics
NPI:1447464912
Name:CUBAS, IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:CUBAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27015
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92198-1015
Mailing Address - Country:US
Mailing Address - Phone:619-489-5611
Mailing Address - Fax:619-566-4057
Practice Address - Street 1:629 THIRD AVE STE A
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5786
Practice Address - Country:US
Practice Address - Phone:619-489-5611
Practice Address - Fax:619-566-4057
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPT21616207RG0100X
CAC55825207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300150158Medicaid