Healthcare Provider Details

I. General information

NPI: 1508220443
Provider Name (Legal Business Name): LA VEREDA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 E SOUTHERN AVE SUITE G
TEMPE AZ
85282-7610
US

IV. Provider business mailing address

2600 E SOUTHERN AVE SUITE G
TEMPE AZ
85282-7610
US

V. Phone/Fax

Practice location:
  • Phone: 480-454-8611
  • Fax: 480-219-8940
Mailing address:
  • Phone: 480-454-8611
  • Fax: 480-219-8940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. COREY SKUBISZ
Title or Position: NATUROPATHIC MEDICAL DOCTOR
Credential: NMD
Phone: 480-454-8611