Healthcare Provider Details

I. General information

NPI: 1205986163
Provider Name (Legal Business Name): VIOLA YBANEZ TABOADA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 SE 5TH TER
CRYSTAL RIVER FL
34429-4852
US

IV. Provider business mailing address

730 SE 5TH TER
CRYSTAL RIVER FL
34429-4852
US

V. Phone/Fax

Practice location:
  • Phone: 352-795-2245
  • Fax:
Mailing address:
  • Phone: 352-795-2245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number29972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: