Basic Information
| Provider Information | |||||||||
| NPI: | 1730708736 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUBBARD | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | MARGARET | ||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8715 CRYSTAL RIVER WAY | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958285140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167052297 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8801 FOLSOM BLVD STE 195 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958263231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163824447 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2020 | ||||||||
| LastUpdateDate: | 04/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
ID Information
| ID | Type | State | Issuer | Description | 91132829D-01 | 05 | CA | MEDICAID |