Healthcare Provider Details

I. General information

NPI: 1447305438
Provider Name (Legal Business Name): BRYAN DAVID HUBBARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 S GRAND AVE
LOS ANGELES CA
90015-3070
US

IV. Provider business mailing address

PO BOX 1304
REDONDO BEACH CA
90278-0304
US

V. Phone/Fax

Practice location:
  • Phone: 213-673-1478
  • Fax:
Mailing address:
  • Phone: 213-673-1478
  • Fax: 310-347-4318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG079530
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD600003711
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: