Provider Demographics
NPI:1184640641
Name:LAUBLY, JUSTINE NATASHA (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:NATASHA
Last Name:LAUBLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:NATASHA
Other - Last Name:LAUBLY-DIAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2020 SUTTER PL
Practice Address - Street 2:STE. 101
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6213
Practice Address - Country:US
Practice Address - Phone:530-750-5900
Practice Address - Fax:530-750-5914
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G750770Medicaid
CA00G750771OtherBLUE SHIELD
CA080185216OtherRR MEDICARE
CA00G750773Medicare ID - Type Unspecified
CA00G750770Medicaid