Provider Demographics
NPI:1881189710
Name:DUBE, BETHANY (PA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:DUBE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3104 4TH ST APT 107
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5452
Mailing Address - Country:US
Mailing Address - Phone:978-618-5127
Mailing Address - Fax:
Practice Address - Street 1:120 S SPALDING DR STE 340
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1841
Practice Address - Country:US
Practice Address - Phone:310-777-8800
Practice Address - Fax:310-861-1722
Is Sole Proprietor?:No
Enumeration Date:2018-06-23
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55697363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant