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General NPI Number Information
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NPI Number | 1508220443
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Entity Type | Organization
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Legal Business Name | LA VEREDA MEDICAL CENTER
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 2600 E SOUTHERN AVE SUITE G
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City | TEMPE
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State | AZ
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Zip | 85282-7610
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Country | US
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Telephone | 480-454-8611
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Fax | 480-219-8940
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Provider Business Mailing Address
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Address Line | 2600 E SOUTHERN AVE SUITE G
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City | TEMPE
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State | AZ
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Zip | 85282-7610
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Country | US
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Telephone | 480-454-8611
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Fax | 480-219-8940
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Authorized Official
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Title or Position | NATUROPATHIC MEDICAL DOCTOR
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Name | MR. COREY SKUBISZ
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Credential | NMD
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Telephone | 480-454-8611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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