Healthcare Provider Details

I. General information

NPI: 1932388659
Provider Name (Legal Business Name): JENNIFER NGUYEN HUBERT, D.O., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 HOPPER AVE # 615
SANTA ROSA CA
95403-1613
US

IV. Provider business mailing address

1014 HOPPER AVE # 615
SANTA ROSA CA
95403-1613
US

V. Phone/Fax

Practice location:
  • Phone: 707-575-3202
  • Fax: 707-579-8820
Mailing address:
  • Phone: 707-575-3202
  • Fax: 707-579-8820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A8236
License Number StateCA

VIII. Authorized Official

Name: DR. JENNIFER HUBERT
Title or Position: PRESIDENT
Credential: D.O.
Phone: 707-575-3202