Healthcare Provider Details

I. General information

NPI: 1124879325
Provider Name (Legal Business Name): HYANGJA HUEBNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 COUNTRY CLUB DR APT D
SIMI VALLEY CA
93065-6647
US

IV. Provider business mailing address

450 COUNTRY CLUB DR APT D
SIMI VALLEY CA
93065-6647
US

V. Phone/Fax

Practice location:
  • Phone: 661-300-0377
  • Fax:
Mailing address:
  • Phone: 661-300-0377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95029413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: