Provider Demographics
NPI:1326568486
Name:DUBE, DAMIAN
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:
Last Name:DUBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 E ELLIOT RD UNIT 1118
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-6754
Mailing Address - Country:US
Mailing Address - Phone:623-396-6743
Mailing Address - Fax:
Practice Address - Street 1:1503 N ROCKWELL ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-1436
Practice Address - Country:US
Practice Address - Phone:623-396-6743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education