Healthcare Provider Details

I. General information

NPI: 1942310313
Provider Name (Legal Business Name): JENNIFER HUBERT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 4TH ST # 185
SANTA ROSA CA
95405-4726
US

IV. Provider business mailing address

2751 4TH ST # 185
SANTA ROSA CA
95405-4726
US

V. Phone/Fax

Practice location:
  • Phone: 707-579-5520
  • Fax: 707-579-8820
Mailing address:
  • Phone: 707-318-9799
  • Fax:

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:
Title or Position:
Credential:
Phone: