Healthcare Provider Details

I. General information

NPI: 1588252761
Provider Name (Legal Business Name): ERIC NUBLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15585 MONTEREY RD STE D
MORGAN HILL CA
95037-5460
US

IV. Provider business mailing address

100 PALM VALLEY BLVD APT 1043
SAN JOSE CA
95123-1092
US

V. Phone/Fax

Practice location:
  • Phone: 669-377-1133
  • Fax:
Mailing address:
  • Phone: 925-549-1592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT299503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: