Provider Demographics
NPI:1538223698
Name:KOLIBAS, LAUNA FAYE
Entity type:Individual
Prefix:MRS
First Name:LAUNA
Middle Name:FAYE
Last Name:KOLIBAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9608 E MONTEREY AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-2246
Mailing Address - Country:US
Mailing Address - Phone:480-358-9336
Mailing Address - Fax:480-358-9336
Practice Address - Street 1:9608 E MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-2246
Practice Address - Country:US
Practice Address - Phone:480-358-9336
Practice Address - Fax:480-358-9336
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4975385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child