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NPI Code Detail

MEDICARE: YISROEL LOEB

MEDICARE: YISROEL LOEB
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
1103T00000XPsychologist

General Provider Information

NPI Number : 1861891459
Entity Type Code : Individual
Provider Name (Legal Business Name) : YISROEL LOEB
Provider Business Mailing Address
First Line : 7301 N 16TH ST STE 102
Second Line :
City : PHOENIX
State : AZ
Zip : 85020-5266
Country : US
Telephone Number : 602-730-5307
Fax Number :
Provider Business Practice Location Address
First Line : 7301 N 16TH ST STE 102
Second Line :
City : PHOENIX
State : AZ
Zip : 85020-5266
Country : US
Telephone Number : 602-730-5307
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2014
Last Update Date : 04/20/2021

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Directions to “ YISROEL LOEB ” Practice Location

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