Individual
MARILYNN KIRCHUBEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2160 W GRANT LINE RD STE 230, TRACY, CA 95377-7334
(209) 832-8700
(209) 832-2210
Mailing address
2160 W GRANT LINE RD, STE 230, TRACY, CA 95377-7334
(209) 832-8700
(209) 832-2210
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 11603
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA 11603
STATE OF CALIFORNIA PHYSICIAN ASSISTANT LICENSE
CA
Enumeration date
04/17/2014
Last updated
05/10/2017
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