Provider Demographics
NPI:1790503795
Name:PBN UNIVERSAL HEALING LLC
Entity type:Organization
Organization Name:PBN UNIVERSAL HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:PROSCOVIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LUBWAMA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:818-401-3293
Mailing Address - Street 1:6200 DE SOTO AVE APT 35103
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-0202
Mailing Address - Country:US
Mailing Address - Phone:818-401-3293
Mailing Address - Fax:
Practice Address - Street 1:9313 S 39TH DR
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-1237
Practice Address - Country:US
Practice Address - Phone:818-401-3293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty