Active NPI
Marilynn Kirchubel, P.A.
- Medical Physician Assistant
- Tracy, CA
National Provider Identifier
1881014702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA 11603
- Practice address
- 2160 W Grant Line Rd Ste 230
Tracy, CA 95377-7334 - Phone
- (209) 832-8700
- Fax
- (209) 832-2210
- NPI assigned
- Apr 17, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA 11603 | CA | Primary |
Addresses
Primary practice location
2160 W Grant Line Rd Ste 230
Tracy, CA 95377-7334
Mailing address
2160 W Grant Line Rd
Ste 230
Tracy, CA 95377-7334
Phone (209) 832-8700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA 11603 | Other | CA | STATE OF CALIFORNIA PHYSICIAN ASSISTANT LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA 11603 | CA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1397692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494374400000",
"number": "1881014702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2160 W GRANT LINE RD",
"address_2": "STE 230",
"city": "TRACY",
"state": "CA",
"postal_code": "953777334",
"telephone_number": "209-832-8700",
"fax_number": "209-832-2210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2160 W GRANT LINE RD STE 230",
"city": "TRACY",
"state": "CA",
"postal_code": "953777334",
"telephone_number": "209-832-8700",
"fax_number": "209-832-2210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRCHUBEL",
"first_name": "MARILYNN",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-17",
"last_updated": "2017-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "PA 11603",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF CALIFORNIA PHYSICIAN ASSISTANT LICENSE",
"identifier": "PA 11603",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tracy, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.