Healthcare Provider Details

I. General information

NPI: 1659539468
Provider Name (Legal Business Name): KYMLA EUBANKS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E. CURRY ROAD NO MAIL
TEMPE AZ
85281
US

IV. Provider business mailing address

PO BOX 7608
TEMPE AZ
85281-0021
US

V. Phone/Fax

Practice location:
  • Phone: 480-965-1082
  • Fax: 480-727-9697
Mailing address:
  • Phone: 480-965-1082
  • Fax: 480-727-9697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number331210
License Number StateAZ

VIII. Authorized Official

Name: KYMLA J EUBANKS
Title or Position: DIRECTOR
Credential: MT-BC
Phone: 480-965-1082