Healthcare Provider Details

I. General information

NPI: 1730456591
Provider Name (Legal Business Name): JUDY TUBBS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 S HARBOR BLVD
SANTA ANA CA
92704-6919
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 714-929-2304
  • Fax:
Mailing address:
  • Phone: 714-929-2300
  • Fax: 714-929-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: