Healthcare Provider Details

I. General information

NPI: 1710089677
Provider Name (Legal Business Name): DAVID RICHARDSON HUBBARD JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14781 POMERADO RD #221
POWAY CA
92064-2802
US

IV. Provider business mailing address

14781 POMERADO RD #221
POWAY CA
92064-2802
US

V. Phone/Fax

Practice location:
  • Phone: 858-668-3380
  • Fax: 858-668-3384
Mailing address:
  • Phone: 858-668-3380
  • Fax: 858-668-3384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberG50317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: