Healthcare Provider Details

I. General information

NPI: 1528633997
Provider Name (Legal Business Name): MARIANO D CIBRAN, MD CORP DBA ST PETERSBURG PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 PARK BLVD N
PINELLAS PARK FL
33781-3714
US

IV. Provider business mailing address

2115 CENTRAL AVE
ST PETERSBURG FL
33713-8815
US

V. Phone/Fax

Practice location:
  • Phone: 727-544-5437
  • Fax:
Mailing address:
  • Phone: 727-526-9135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY MCPHAIL
Title or Position: ADMINISTRATOR
Credential:
Phone: 727-526-9135