Healthcare Provider Details

I. General information

NPI: 1164461224
Provider Name (Legal Business Name): JOHN W. SKUBIC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W LUGONIA AVE STE 310
REDLANDS CA
92374-9706
US

IV. Provider business mailing address

1801 ORANGE TREE LN STE 200
REDLANDS CA
92374-4587
US

V. Phone/Fax

Practice location:
  • Phone: 909-557-1600
  • Fax: 909-557-1732
Mailing address:
  • Phone: 909-557-1600
  • Fax: 909-796-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG54082
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: