Provider Demographics
NPI:1558135681
Name:MALIBU THERAPUTICS LLC
Entity Type:Organization
Organization Name:MALIBU THERAPUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MALIBU
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-366-5690
Mailing Address - Street 1:12681 CHIEFS CT
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12681 CHIEFS CT
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9553
Practice Address - Country:US
Practice Address - Phone:317-523-4637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty