Basic Information
| Provider Information | |||||||||
| NPI: | 1730734005 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUBBARD | ||||||||
| FirstName: | SHERONDA | ||||||||
| MiddleName: | GAIL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 ALASKA AVE APT 99 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945337442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074191301 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7567 AMADOR VALLEY BLVD STE 109 | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945682442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662062008 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2019 | ||||||||
| LastUpdateDate: | 08/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.