MEDICARE: JENNIFER NGUYEN HUBERT, D.O., INC

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	207R00000X	Internal Medicine Physician	20A8236	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932388659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER NGUYEN HUBERT, D.O., INC

Provider Business Mailing Address
First Line	:	1014 HOPPER AVE
Second Line	:	# 615
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1613
Country	:	US
Telephone Number	:	707-575-3202
Fax Number	:	707-579-8820

Provider Business Practice Location Address
First Line	:	1014 HOPPER AVE
Second Line	:	# 615
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1613
Country	:	US
Telephone Number	:	707-575-3202
Fax Number	:	707-579-8820

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JENNIFER HUBERT
Credential	:	D.O.
Telephone Number	:	707-575-3202

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	01/03/2008

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