Healthcare Provider Details

I. General information

NPI: 1154039030
Provider Name (Legal Business Name): MICHAEL ANTHONY HOBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 25TH ST
SAN DIEGO CA
92102-2738
US

IV. Provider business mailing address

835 25TH ST
SAN DIEGO CA
92102-2738
US

V. Phone/Fax

Practice location:
  • Phone: 619-239-9691
  • Fax:
Mailing address:
  • Phone: 619-239-9691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: