Healthcare Provider Details

I. General information

NPI: 1508258963
Provider Name (Legal Business Name): CIBELE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6039 COLLINS AVE APT 115
MIAMI BEACH FL
33140-2203
US

IV. Provider business mailing address

6039 COLLINS AVE APT 115
MIAMI BEACH FL
33140-2203
US

V. Phone/Fax

Practice location:
  • Phone: 713-542-4522
  • Fax:
Mailing address:
  • Phone: 713-542-4522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME39137
License Number StateFL

VIII. Authorized Official

Name: GREGORIO ZUAZU
Title or Position: OWNER
Credential: MD
Phone: 713-542-4522