Individual
JONATHAN MICHAEL DUBOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
111 SMITH RANCH RD, SAN RAFAEL, CA 94903-1939
(415) 491-3000
Mailing address
524 RELIANT WAY, AMERICAN CANYON, CA 94503-3239
(310) 966-7767
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY33913
CA
172V00000X
Community Health Worker
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/14/2014
Last updated
04/10/2023
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