Healthcare Provider Details

I. General information

NPI: 1841450327
Provider Name (Legal Business Name): RICARDO P MARIBONA DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13240 N CLEVELAND AVE STE 3
NORTH FORT MYERS FL
33903-4855
US

IV. Provider business mailing address

8851 BOARDROOM CIR
FORT MYERS FL
33919-4888
US

V. Phone/Fax

Practice location:
  • Phone: 239-481-7000
  • Fax: 239-481-8150
Mailing address:
  • Phone: 239-481-7000
  • Fax: 239-481-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2055
License Number StateFL

VIII. Authorized Official

Name: DR. RICARDO P MARIBONA
Title or Position: OWNER
Credential: DPM
Phone: 239-481-7000