Healthcare Provider Details

I. General information

NPI: 1760441174
Provider Name (Legal Business Name): ROBERT PHILIP LUBERTO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7717 W. DEER VALLEY RD. SUITE 125
PEORIA AZ
85382
US

IV. Provider business mailing address

7717 W DEER VALLEY RD SUITE 125
PEORIA AZ
85382
US

V. Phone/Fax

Practice location:
  • Phone: 623-561-6300
  • Fax: 623-572-5400
Mailing address:
  • Phone: 623-561-6300
  • Fax: 623-572-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number3176
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: