Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | G055771 | CA |
NPI | 1386668507 |
---|---|
Provider Name | Gary Hubert |
First Address | Woodland Hills, CA 91364-4661 |
Second Address | Thousand Oaks, CA 91361-1201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A99525 | (02) | CA |
G055771 | MEDICAL LISCENSE (01) | CA |