Healthcare Provider Details

I. General information

NPI: 1659919140
Provider Name (Legal Business Name): TUBI CONNECT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2019
Last Update Date: 12/28/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DR STE C117
LA JOLLA CA
92037-1707
US

IV. Provider business mailing address

2434 MEADOW LARK DR
SAN DIEGO CA
92123-3316
US

V. Phone/Fax

Practice location:
  • Phone: 858-997-0235
  • Fax:
Mailing address:
  • Phone: 858-997-7415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIM HUYNH
Title or Position: ADMINISTRATOR
Credential:
Phone: 858-997-7415