Provider Demographics
NPI:1912386137
Name:SKUBISZ, COREY (NMD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:
Last Name:SKUBISZ
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
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
Practice Address - Country:US
Practice Address - Phone:480-454-8611
Practice Address - Fax:480-219-8940
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15-1490175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath