Provider Demographics
NPI:1508220443
Name:LA VEREDA MEDICAL CENTER
Entity Type:Organization
Organization Name:LA VEREDA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SKUBISZ
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:480-454-8611
Mailing Address - Street 1:2600 E SOUTHERN AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7610
Mailing Address - Country:US
Mailing Address - Phone:480-454-8611
Mailing Address - Fax:480-219-8940
Practice Address - Street 1:2600 E SOUTHERN AVE
Practice Address - Street 2:SUITE G
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7610
Practice Address - Country:US
Practice Address - Phone:480-454-8611
Practice Address - Fax:480-219-8940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty