Provider Demographics
NPI:1740435726
Name:KUBACZ, CHERYL LYNN (NMD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:LYNN
Last Name:KUBACZ
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:SLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NMD
Mailing Address - Street 1:PO BOX 44384
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064
Mailing Address - Country:US
Mailing Address - Phone:602-576-8504
Mailing Address - Fax:
Practice Address - Street 1:10214 N. TATUM BLVD STE B-300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028
Practice Address - Country:US
Practice Address - Phone:480-991-7900
Practice Address - Fax:480-991-7907
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08-1090175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath