Healthcare Provider Details

I. General information

NPI: 1386418564
Provider Name (Legal Business Name): JILL HOUBE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201-224 W. ESPLANADE NORTH VANCOUVER
NORTH VANCOUVER BRITISH COLUMBIA
V7M 1A4
CA

IV. Provider business mailing address

1582 GULF RD UNIT 1699
POINT ROBERTS WA
98281-0049
US

V. Phone/Fax

Practice location:
  • Phone: 604-337-7425
  • Fax:
Mailing address:
  • Phone: 778-384-0708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number61383109
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: