Healthcare Provider Details

I. General information

NPI: 1881965549
Provider Name (Legal Business Name): SONJA R HUBBARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 03/31/2022
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HERITAGE HEALTH CARE 38209 47TH ST E, SUITE C
PALMDALE CA
93552-3113
US

IV. Provider business mailing address

43839 15TH ST W
LANCASTER CA
93534-4756
US

V. Phone/Fax

Practice location:
  • Phone: 661-272-3777
  • Fax: 661-272-9107
Mailing address:
  • Phone: 661-945-5984
  • Fax: 661-951-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: