Provider Demographics
NPI:1992879472
Name:HUBBARD, RUSSELL BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:BRUCE
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:MD
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 1770
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91944-1770
Mailing Address - Country:US
Mailing Address - Phone:619-295-8005
Mailing Address - Fax:619-297-1700
Practice Address - Street 1:1565 HOTEL CIR S STE 310
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3419
Practice Address - Country:US
Practice Address - Phone:619-295-8005
Practice Address - Fax:619-297-1700
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG256802084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G25680OtherMEDI-CAL
CAG25680Medicare ID - Type Unspecified
CA00G25680OtherMEDI-CAL