Provider Demographics
NPI:1104218593
Name:HUBBELL FERNANDEZ, ALICIA ROSE (LM)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ROSE
Last Name:HUBBELL FERNANDEZ
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40739 MALIBAR AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-7322
Mailing Address - Country:US
Mailing Address - Phone:951-394-3936
Mailing Address - Fax:
Practice Address - Street 1:40739 MALIBAR AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-7322
Practice Address - Country:US
Practice Address - Phone:951-394-3936
Practice Address - Fax:619-354-5196
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM427176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife