Healthcare Provider Details

I. General information

NPI: 1386891166
Provider Name (Legal Business Name): CRISTOBAL YUBETA JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

23416 N 81ST ST
SCOTTSDALE AZ
85255-3530
US

V. Phone/Fax

Practice location:
  • Phone: 602-884-1857
  • Fax:
Mailing address:
  • Phone: 480-466-5677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA0634
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: