MEDICARE: IONELA O HUBBARD LAC, DOM, IFMCP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC4756	CA
2	133NN1002X	Nutrition Education Nutritionist	AC4756	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1790711935	OTHER	CA	CMV
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790711935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IONELA O HUBBARD LAC, DOM, IFMCP

Provider Business Mailing Address
First Line	:	57 PLYMOUTH
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-2642
Country	:	US
Telephone Number	:	909-478-0600
Fax Number	:	909-478-0618

Provider Business Practice Location Address
First Line	:	12341 NEWPORT AVE STE A200
Second Line	:
City	:	NORTH TUSTIN
State	:	CA
Zip	:	92705-8202
Country	:	US
Telephone Number	:	949-726-0707
Fax Number	:	949-258-8726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/22/2024

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