Healthcare Provider Details

I. General information

NPI: 1679921845
Provider Name (Legal Business Name): LILIBETH GIRALDO MENKE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LILIBETH NATALIE GIRALDO DO

II. Dates (important events)

Enumeration Date: 05/29/2016
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8787 BRYAN DAIRY RD STE 250
LARGO FL
33777-1259
US

IV. Provider business mailing address

8787 BRYAN DAIRY RD STE 250
LARGO FL
33777-1259
US

V. Phone/Fax

Practice location:
  • Phone: 727-391-6296
  • Fax: 813-635-7940
Mailing address:
  • Phone: 727-391-6296
  • Fax: 813-635-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS16149
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberUO4904
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: