Healthcare Provider Details

I. General information

NPI: 1841996816
Provider Name (Legal Business Name): PAUL WILLIAM URIBE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 EDGEWATER DR APT 204
CORAL GABLES FL
33133-6914
US

IV. Provider business mailing address

90 EDGEWATER DR APT 204
CORAL GABLES FL
33133-6914
US

V. Phone/Fax

Practice location:
  • Phone: 912-541-1575
  • Fax:
Mailing address:
  • Phone: 912-541-1575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: