1407958507 NPI number — MARIBEL DEL CARMEN BIEBERACH MD

Table of content: MARIBEL DEL CARMEN BIEBERACH MD (NPI 1407958507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407958507 NPI number — MARIBEL DEL CARMEN BIEBERACH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIEBERACH
Provider First Name:
MARIBEL
Provider Middle Name:
DEL CARMEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIAZ
Provider Other First Name:
MARIBEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1407958507
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9900 SE SUNNYSIDE ROAD
Provider Second Line Business Mailing Address:
DEPT OF PHYSIATRY
Provider Business Mailing Address City Name:
CLACKAMAS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-571-3674
Provider Business Mailing Address Fax Number:
503-571-8976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9900 SE SUNNYSIDE ROAD
Provider Second Line Business Practice Location Address:
SUNNYBROOK MEDICAL OFFICE, PHYSIATRY DEPT.
Provider Business Practice Location Address City Name:
CLACKAMAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97015-9750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-571-3674
Provider Business Practice Location Address Fax Number:
503-571-8976
Provider Enumeration Date:
09/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  MD22624 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208100000X , with the licence number: MD00041221 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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