| Russell Bruce Hubbard Md Inc | |
|
1565 Hotel Cir S Ste 310 San Diego CA 92108-3419 | |
| (619) 295-8005 | |
| (619) 297-1700 |
| Full Name | Russell Bruce Hubbard Md Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1565 Hotel Cir S Ste 310, San Diego, California |
| Authorized Official Name and Position | Russell Bruce Hubbard (OWNER) |
| Authorized Official Contact | 6192958005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Russell Bruce Hubbard Md Inc Po Box 1770 La Mesa CA 91944-1770 Ph: (619) 295-8005 | Russell Bruce Hubbard Md Inc 1565 Hotel Cir S Ste 310 San Diego CA 92108-3419 Ph: (619) 295-8005 |
| NPI Number | 1053430744 |
|---|---|
| Provider Enumeration Date | 03/27/2007 |
| Last Update Date | 04/22/2020 |
| Certification Date | 04/22/2020 |
| Medicare PECOS PAC ID | 7810056744 |
|---|---|
| Medicare Enrollment ID | O20081107000176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053430744 | NPI | - | NPPES |
| 125585700 | Other | CA | OWCPACS (DEPT. LABOR WC) |
| G25680 | Other | CA | MEDICAL LICENSE # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 2084P0802X | Psychiatry & Neurology - Addiction Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | Russell B Hubbard |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992879472 PECOS PAC ID: 5193884021 Enrollment ID: I20081107000162 |
| Provider Name | Karishma M Patel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740644111 PECOS PAC ID: 3375949092 Enrollment ID: I20210903002532 |
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