Healthcare Provider Details

I. General information

NPI: 1891855912
Provider Name (Legal Business Name): MOREY JACK BUBIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR
LA MESA CA
91942
US

IV. Provider business mailing address

PO BOX 3617
LA MESA CA
91944-3617
US

V. Phone/Fax

Practice location:
  • Phone: 619-460-5111
  • Fax: 619-460-7815
Mailing address:
  • Phone: 619-460-5111
  • Fax: 619-460-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG26072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: