Healthcare Provider Details

I. General information

NPI: 1588193031
Provider Name (Legal Business Name): BRETT HULBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57475 29 PALMS HWY
YUCCA VALLEY CA
92284-2906
US

IV. Provider business mailing address

57475 29 PALMS HWY STE 101
YUCCA VALLEY CA
92284-2906
US

V. Phone/Fax

Practice location:
  • Phone: 760-228-1855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: