Provider Demographics
NPI:1265559231
Name:SHIBUYA, PETER L S (PHD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:L S
Last Name:SHIBUYA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5174 N VIA DE LA LANZA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-7077
Mailing Address - Country:US
Mailing Address - Phone:520-405-3456
Mailing Address - Fax:
Practice Address - Street 1:5174 N VIA DE LA LANZA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-7077
Practice Address - Country:US
Practice Address - Phone:520-405-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool