Healthcare Provider Details

I. General information

NPI: 1033388780
Provider Name (Legal Business Name): JYOTI S. LEBONHEUR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 S. STAPLEY DRIVE SUITE 101
MESA AZ
85204
US

IV. Provider business mailing address

11001 N BLACK CANYON HWY
PHOENIX AZ
85029-4757
US

V. Phone/Fax

Practice location:
  • Phone: 480-464-8500
  • Fax:
Mailing address:
  • Phone: 602-371-2515
  • Fax: 602-371-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26204
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: