Provider Demographics
NPI:1043473069
Name:HUBBARD, DEREK LEE (LAC)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:LEE
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:11832 UIOWA AVE #9
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049
Mailing Address - Country:US
Mailing Address - Phone:310-988-5602
Mailing Address - Fax:
Practice Address - Street 1:3831 HUGHES AVE
Practice Address - Street 2:SUITE 601 CULVER MEDICAL PLAZA
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232
Practice Address - Country:US
Practice Address - Phone:310-988-5602
Practice Address - Fax:310-838-0491
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC12236171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist