Healthcare Provider Details

I. General information

NPI: 1649590639
Provider Name (Legal Business Name): CORBIN LEBEAU RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE INDIAN HILL RD
WINTERHAVEN CA
92283
US

IV. Provider business mailing address

PO BOX 1368
YUMA AZ
85366-2361
US

V. Phone/Fax

Practice location:
  • Phone: 760-572-4100
  • Fax: 760-572-2133
Mailing address:
  • Phone: 760-572-4100
  • Fax: 760-572-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR026001
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: