Healthcare Provider Details

I. General information

NPI: 1790022135
Provider Name (Legal Business Name): RIB OF ORLANDO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 GARDEN PLZ
ORLANDO FL
32803-4212
US

IV. Provider business mailing address

718 GARDEN PLZ
ORLANDO FL
32803-4212
US

V. Phone/Fax

Practice location:
  • Phone: 407-894-8894
  • Fax: 407-894-8893
Mailing address:
  • Phone: 407-894-8894
  • Fax: 407-894-8893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: IRIS ELOMINA BUCKLEY
Title or Position: MANAGING PARNTER
Credential:
Phone: 407-488-3557