Provider Demographics
NPI:1467698811
Name:JUBB, SONYA MARIANA (NMW)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:MARIANA
Last Name:JUBB
Suffix:
Gender:F
Credentials:NMW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-204-3977
Mailing Address - Fax:510-204-5129
Practice Address - Street 1:2450 ASHBY AVE RM 3040
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2067
Practice Address - Country:US
Practice Address - Phone:510-204-3977
Practice Address - Fax:510-204-5429
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW1815176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1815OtherSTATE MEDICAL LICENSE