Healthcare Provider Details

I. General information

NPI: 1407798259
Provider Name (Legal Business Name): MALIBIANO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3142 NORTHSIDE DR
KEY WEST FL
33040-8012
US

IV. Provider business mailing address

513 OLIVIA ST
KEY WEST FL
33040-7438
US

V. Phone/Fax

Practice location:
  • Phone: 305-615-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JERRY JACKSON
Title or Position: PRESIDENT
Credential: MD
Phone: 305-615-3300