Healthcare Provider Details

I. General information

NPI: 1285675520
Provider Name (Legal Business Name): JAVIER FRANCISCO MARIBONA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8582 SW 40TH ST
MIAMI FL
33155-3214
US

IV. Provider business mailing address

5740 SW 58TH CT
SOUTH MIAMI FL
33143-2326
US

V. Phone/Fax

Practice location:
  • Phone: 305-551-3412
  • Fax: 395-551-1945
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO 2126
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: