Healthcare Provider Details

I. General information

NPI: 1639591746
Provider Name (Legal Business Name): VICKI HOBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 N MOUNTAIN AVE STE A
UPLAND CA
91786-3658
US

IV. Provider business mailing address

916 N MOUNTAIN AVE STE A
UPLAND CA
91786-3658
US

V. Phone/Fax

Practice location:
  • Phone: 909-932-1069
  • Fax: 909-932-1087
Mailing address:
  • Phone: 909-932-1069
  • Fax: 909-932-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: