Active NPI
Tamara Lynn Kubiak, LMFT
- Marriage & Family Therapist
- Costa Mesa, CA
National Provider Identifier
1417513326
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 100389
- Practice address
- 2900 Bristol St Ste G201
Costa Mesa, CA 92626-7914 - Phone
- (949) 445-3160
- NPI assigned
- May 15, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 100389 | CA | Primary |
Addresses
Primary practice location
2900 Bristol St Ste G201
Costa Mesa, CA 92626-7914
Mailing address
413 Flower St
Costa Mesa, CA 92627-2311
Phone (949) 887-8020
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 9, 2024 through Jan 9, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557878400000",
"number": "1417513326",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "413 FLOWER ST",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926272311",
"telephone_number": "949-887-8020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 BRISTOL ST STE G201",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926267914",
"telephone_number": "949-445-3160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUBIAK",
"first_name": "TAMARA",
"middle_name": "LYNN",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-15",
"last_updated": "2019-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "100389",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.