Individual
JOHN P. LUBISICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
150 W WASHINGTON ST, SAN DIEGO, CA 92103-2005
(866) 558-4320
(619) 294-8399
Mailing address
150 W WASHINGTON ST, SAN DIEGO, CA 92103-2005
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2000161496
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142019001
—
AR
01
—
173098
MO BLUE SHIELD
MO
05
—
205079403
—
MO
01
—
98753
ARK BLUE SHIELD
AR
Enumeration date
02/02/2007
Last updated
04/12/2021
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