Healthcare Provider Details

I. General information

NPI: 1316315195
Provider Name (Legal Business Name): MATTHEW KIBURIS PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10751 W OVERLAND RD
BOISE ID
83709-1330
US

IV. Provider business mailing address

750 N IMPERIAL AVE
EL CENTRO CA
92243-1914
US

V. Phone/Fax

Practice location:
  • Phone: 208-373-5233
  • Fax:
Mailing address:
  • Phone: 760-353-4603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP7964
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number64848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: