Healthcare Provider Details

I. General information

NPI: 1326568486
Provider Name (Legal Business Name): DAMIAN DUBE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 N ROCKWELL ST
GILBERT AZ
85234-1436
US

IV. Provider business mailing address

137 E ELLIOT RD UNIT 1118
GILBERT AZ
85299-6754
US

V. Phone/Fax

Practice location:
  • Phone: 623-396-6743
  • Fax:
Mailing address:
  • Phone: 623-396-6743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: