Provider Demographics
NPI:1699561084
Name:HUBBARD, DEIDRA A
Entity type:Individual
Prefix:
First Name:DEIDRA
Middle Name:A
Last Name:HUBBARD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2133
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-0133
Mailing Address - Country:US
Mailing Address - Phone:323-806-6277
Mailing Address - Fax:
Practice Address - Street 1:500 E ARBOR VITAE ST APT 1
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3573
Practice Address - Country:US
Practice Address - Phone:323-806-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst