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General NPI Number Information
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NPI Number | 1205251451
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Entity Type | Organization
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Legal Business Name | PB & J-S LLC
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Dates
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Enumeration Date | 02/25/2014
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Last Update Date | 05/29/2014
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Provider Practice Location Address
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Address Line | 701 N SCOTTSDALE RD
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-4219
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Country | US
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Telephone | 480-656-6330
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Fax |
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Provider Business Mailing Address
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Address Line | 701 N SCOTTSDALE RD
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-4219
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Country | US
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Telephone | 480-656-6330
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Fax |
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | PETER K KUBITZ
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Credential | D.O.
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Telephone | 480-254-4954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 4087
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License Number State | AZ
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