Healthcare Provider Details

I. General information

NPI: 1386668507
Provider Name (Legal Business Name): GARY HUBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 ROLLING OAKS DR #110
THOUSAND OAKS CA
91361-1201
US

IV. Provider business mailing address

4640 TENANGO DR
WOODLAND HILLS CA
91364-4661
US

V. Phone/Fax

Practice location:
  • Phone: 805-778-1122
  • Fax: 805-778-0610
Mailing address:
  • Phone: 805-778-1122
  • Fax: 805-778-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberG055771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: