Healthcare Provider Details

I. General information

NPI: 1316504301
Provider Name (Legal Business Name): CECILIA LARIBA BIBIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 EDGEWOOD RD
EDGEWOOD MD
21040-1606
US

IV. Provider business mailing address

1369 TRALEE CIR
ABERDEEN MD
21001-2643
US

V. Phone/Fax

Practice location:
  • Phone: 443-409-6616
  • Fax: 443-437-4869
Mailing address:
  • Phone: 443-409-6616
  • Fax: 443-437-4869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR185828
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR185828
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR185828
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: