Healthcare Provider Details

I. General information

NPI: 1447436928
Provider Name (Legal Business Name): DAVID STUBBINS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 NATIONAL DR 170
SACRAMENTO CA
95834-1947
US

IV. Provider business mailing address

PO BOX 2154
DAVIS CA
95617-2154
US

V. Phone/Fax

Practice location:
  • Phone: 530-792-1606
  • Fax:
Mailing address:
  • Phone: 530-792-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY9389
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY9389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: