Basic Information
| Provider Information | |||||||||
| NPI: | 1467698811 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUBB | ||||||||
| FirstName: | SONYA | ||||||||
| MiddleName: | MARIANA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | NMW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 DISTEL CIR | ||||||||
| Address2: | |||||||||
| City: | LOS ALTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940221408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102043977 | ||||||||
| FaxNumber: | 5102045129 | ||||||||
| Practice Location | |||||||||
| Address1: | 2450 ASHBY AVE RM 3040 | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947052067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102043977 | ||||||||
| FaxNumber: | 5102045429 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2009 | ||||||||
| LastUpdateDate: | 03/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | NMW1815 | CA | Y | Other Service Providers | Midwife |
ID Information
| ID | Type | State | Issuer | Description | 1815 | 01 | CA | STATE MEDICAL LICENSE | OTHER |