1699773895 NPI number — NIVEA R RIBAS M D

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699773895 NPI number — NIVEA R RIBAS M D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIBAS
Provider First Name:
NIVEA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699773895
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5801 NW 151ST ST
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
MIAMI LAKES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33014-2437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-826-3931
Provider Business Mailing Address Fax Number:
305-826-5102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5801 NW 151ST ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
MIAMI LAKES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33014-2437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-826-3931
Provider Business Practice Location Address Fax Number:
305-826-5102
Provider Enumeration Date:
07/12/2005

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: 2084N0400X , with the licence number:  0064461 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004295 . This is a "NEIGBORHOOD POVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7027301 . This is a "SUNCOAST" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 374412400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: SL04500 . This is a "CAREPLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 23410 . This is a "BCBS INDIVIDUAL #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 222657 . This is a "AVMED PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00249728 . This is a "PALMETTO GBA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 374412400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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