Provider Demographics
NPI:1053339127
Name:HUBLI, SHITAL C (MD)
Entity type:Individual
Prefix:DR
First Name:SHITAL
Middle Name:C
Last Name:HUBLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 BESSIE AVE
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3417
Mailing Address - Country:US
Mailing Address - Phone:209-833-0525
Mailing Address - Fax:209-830-7361
Practice Address - Street 1:1470 BESSIE AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3417
Practice Address - Country:US
Practice Address - Phone:209-833-0525
Practice Address - Fax:209-830-7361
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI01842Medicare UPIN
CA00A855090Medicare ID - Type Unspecified