MEDICARE: TUBI CONNECT INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist
2	251K00000X	Public Health or Welfare Agency
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
4	261QR1100X	Research Clinic/Center
5	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1659919140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUBI CONNECT INC.

Provider Business Mailing Address
First Line	:	2434 MEADOW LARK DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-3316
Country	:	US
Telephone Number	:	858-997-7415
Fax Number	:

Provider Business Practice Location Address
First Line	:	8950 VILLA LA JOLLA DR STE C117
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-1707
Country	:	US
Telephone Number	:	858-997-0235
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KIM HUYNH
Credential	:
Telephone Number	:	858-997-7415

Provider Enumeration Date	:	12/15/2019
Last Update Date	:	12/28/2023

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