Healthcare Provider Details

I. General information

NPI: 1346239811
Provider Name (Legal Business Name): MARIA A SIBERON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE 25 DE JULIO
GUANICA PR
00653-2105
US

IV. Provider business mailing address

23 CALLE B SANTA CLARA
GUANICA PR
00653-2508
US

V. Phone/Fax

Practice location:
  • Phone: 787-821-2006
  • Fax: 787-821-3767
Mailing address:
  • Phone: 787-821-3014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number4698
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4698
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: