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General NPI Number Information
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NPI Number | 1790503795
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Entity Type | Organization
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Legal Business Name | PBN UNIVERSAL HEALING LLC
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 9313 S 39TH DR
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City | LAVEEN
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State | AZ
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Zip | 85339-1237
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Country | US
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Telephone | 818-401-3293
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Fax |
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Provider Business Mailing Address
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Address Line | 6200 DE SOTO AVE APT 35103
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-0202
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Country | US
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Telephone | 818-401-3293
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Fax |
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Authorized Official
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Title or Position | NP
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Name | PROSCOVIA B LUBWAMA
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Credential | PMHNP
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Telephone | 818-401-3293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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