Healthcare Provider Details

I. General information

NPI: 1891370854
Provider Name (Legal Business Name): LYONS HUBER MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15630 18TH AVE
CLEARLAKE CA
95422-9336
US

IV. Provider business mailing address

512 PINE HILL RD
ANGWIN CA
94508-9613
US

V. Phone/Fax

Practice location:
  • Phone: 707-994-6486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DANIEL HUBER
Title or Position: OWNER
Credential:
Phone: 707-337-4250