Healthcare Provider Details

I. General information

NPI: 1205251451
Provider Name (Legal Business Name): PB & J-S LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N SCOTTSDALE RD
SCOTTSDALE AZ
85257-4219
US

IV. Provider business mailing address

701 N SCOTTSDALE RD
SCOTTSDALE AZ
85257-4219
US

V. Phone/Fax

Practice location:
  • Phone: 480-656-6330
  • Fax:
Mailing address:
  • Phone: 480-656-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number4087
License Number StateAZ

VIII. Authorized Official

Name: PETER K KUBITZ
Title or Position: MEMBER/OWNER
Credential: D.O.
Phone: 480-254-4954