Healthcare Provider Details

I. General information

NPI: 1699876680
Provider Name (Legal Business Name): TAMARA MICHELLE RIBOUL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA ARBOLOTE #1 PLAZA REAL SHOPPING CENTER SUITE #307
GUAYNABO PR
00969
US

IV. Provider business mailing address

URBANIZACION COLINAS DE CUPEY STREET 5 #D-21
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-247-6811
  • Fax:
Mailing address:
  • Phone: 787-755-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16437
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: