Healthcare Provider Details

I. General information

NPI: 1760470934
Provider Name (Legal Business Name): MARIANO D CIBRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
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: 727-526-9135
  • Fax:
Mailing address:
  • Phone: 727-526-9135
  • Fax: 727-526-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME27935
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: