Basic Information
| Provider Information | |||||||||
| NPI: | 1104433077 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUBIN | ||||||||
| FirstName: | STEFANI | ||||||||
| MiddleName: | RENEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 W WOODLAWN AVE | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782123346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2108972237 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1401 UNIVERSAL CITY BLVD | ||||||||
| Address2: | |||||||||
| City: | UNIVERSAL CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781483317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103361524 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2020 | ||||||||
| LastUpdateDate: | 09/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-20-136945 | TX | Y |
No ID Information.