Healthcare Provider Details

I. General information

NPI: 1790060697
Provider Name (Legal Business Name): MICHELLE DULUDE RIBAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE ZENAIDA DULUDE RIBAS M.D.

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 POSADA LN STE C
TEMPLETON CA
93465-4054
US

IV. Provider business mailing address

921 OAK PARK BLVD STE 201
PISMO BEACH CA
93449-3400
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-2253
  • Fax: 805-434-3850
Mailing address:
  • Phone: 805-546-0411
  • Fax: 805-473-4891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA116654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: