Provider Demographics
NPI:1215795117
Name:PEB LLC
Entity type:Organization
Organization Name:PEB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, THIRD-PARTY REPRODUCTION
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:BRY
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:424-286-8366
Mailing Address - Street 1:6720 N SCOTTSDALE RD STE 160
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-4421
Mailing Address - Country:US
Mailing Address - Phone:424-385-0100
Mailing Address - Fax:
Practice Address - Street 1:2825 SANTA MONICA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2429
Practice Address - Country:US
Practice Address - Phone:310-566-1470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility