Healthcare Provider Details

I. General information

NPI: 1538430095
Provider Name (Legal Business Name): DAN CHUBA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2012
Last Update Date: 01/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 LA SERENA WAY
ALAMO CA
94507-2126
US

IV. Provider business mailing address

14 LA SERENA WAY
ALAMO CA
94507-2126
US

V. Phone/Fax

Practice location:
  • Phone: 925-837-3374
  • Fax:
Mailing address:
  • Phone: 925-837-3374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberGFE24213
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD-9531
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: