Provider Demographics
NPI:1629264056
Name:ZUBA, TONI
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:ZUBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15620 N 35TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-3892
Mailing Address - Country:US
Mailing Address - Phone:602-993-8090
Mailing Address - Fax:
Practice Address - Street 1:15620 N 35TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-3892
Practice Address - Country:US
Practice Address - Phone:602-993-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2011-11-03
Deactivation Date:2011-05-25
Deactivation Code:
Reactivation Date:2011-11-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2678429OtherAETNA