Provider Demographics
NPI:1831206036
Name:HUBBARD, ERIC RODNEY (DPM)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:RODNEY
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-3025
Mailing Address - Country:US
Mailing Address - Phone:562-426-5151
Mailing Address - Fax:562-424-3395
Practice Address - Street 1:2333 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-3025
Practice Address - Country:US
Practice Address - Phone:562-426-5151
Practice Address - Fax:562-424-3395
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1294213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E12940Medicaid
CAWE1294BMedicare PIN
CA000E12940Medicaid
CA5684330001Medicare NSC