Provider Demographics
NPI:1780378307
Name:HUBACHEK, SAMANTHA QIRKO (MS)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:QIRKO
Last Name:HUBACHEK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 FLORIDA AVE NW APT 305
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-5044
Mailing Address - Country:US
Mailing Address - Phone:619-540-0053
Mailing Address - Fax:
Practice Address - Street 1:3250 WILSHIRE BLVD # 53
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1577
Practice Address - Country:US
Practice Address - Phone:323-361-7827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist