Provider Demographics
NPI:1447371299
Name:HUBBARD, BRENDA CAROL
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:CAROL
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6627 LEESBURG PL
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-3552
Mailing Address - Country:US
Mailing Address - Phone:209-478-7725
Mailing Address - Fax:
Practice Address - Street 1:6627 LEESBURG PL
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-3552
Practice Address - Country:US
Practice Address - Phone:209-478-7725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator