MEDICARE: AL YOKUBONIS BCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor

General Provider Information

NPI Number	:	1619449949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AL YOKUBONIS BCPC

Provider Business Mailing Address
First Line	:	3509 E SHEA BLVD STE 117
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3339
Country	:	US
Telephone Number	:	480-540-8050
Fax Number	:

Provider Business Practice Location Address
First Line	:	3509 E SHEA BLVD STE 117
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3339
Country	:	US
Telephone Number	:	480-540-8050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2018
Last Update Date	:	12/27/2018

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Directions to “ AL YOKUBONIS BCPC” Practice Location

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