Provider Demographics
NPI:1083791578
Name:HUBBARD, ELAINE MARIE (RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:MARIE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 E ELDER ST STE C
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-5001
Mailing Address - Country:US
Mailing Address - Phone:858-232-2151
Mailing Address - Fax:
Practice Address - Street 1:591 E ELDER ST STE C
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-5001
Practice Address - Country:US
Practice Address - Phone:858-232-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22778124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist