Provider Demographics
NPI:1144437971
Name:SUBIDO, LUISITO GONZALES (MA)
Entity type:Individual
Prefix:MR
First Name:LUISITO
Middle Name:GONZALES
Last Name:SUBIDO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:LOUIE
Other - Middle Name:
Other - Last Name:SUBIDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:4534 GEORGIA ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2640
Mailing Address - Country:US
Mailing Address - Phone:619-708-0312
Mailing Address - Fax:
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-4011
Practice Address - Fax:858-278-2365
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 46594106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist