Serenity Oasis Medical Center Inc

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

SERENITY OASIS MEDICAL CENTER INC

Practice address

14558 Sylvan St Ste 104
Van Nuys, CA 91411-2324

Phone

(818) 208-9344

NPI assigned

Jun 4, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Richard Hubbard, MDNPI 1912121799

Title

Owner/ Medical Director

Phone

(818) 208-9344

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Richard Henry Hubbard, M.D., J.D.

  • Specialist
  • Calexico, CA
  • NPI 1912121799
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654300800000",
    "number": "1023757242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14558 SYLVAN ST STE 104",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914112324",
            "telephone_number": "818-208-9344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14558 SYLVAN ST STE 104",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914112324",
            "telephone_number": "818-208-9344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY OASIS MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-04",
        "last_updated": "2022-06-04",
        "certification_date": "2022-06-04",
        "status": "A",
        "authorized_official_last_name": "HUBBARD",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER/ MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "818-208-9344",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "C22547",
            "identifier": "C22547",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Family Medicine) Physician in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Geriatric Medicine (Family Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.