Basic Information
| Provider Information | |||||||||
| NPI: | 1487919155 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUBBARD | ||||||||
| FirstName: | TRENTON | ||||||||
| MiddleName: | ROSS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9300 VALLEY CHILDRENS PL # SC05 | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936368761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593535700 | ||||||||
| FaxNumber: | 5593535708 | ||||||||
| Practice Location | |||||||||
| Address1: | 1125 E SPRUCE AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592565760 | ||||||||
| FaxNumber: | 5592565761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2012 | ||||||||
| LastUpdateDate: | 03/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 125062383 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080C0008X | A167536 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | Child Abuse Pediatrics | 208000000X | A167536 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.