Healthcare Provider Details

I. General information

NPI: 1962698290
Provider Name (Legal Business Name): IWONA CIBA DPM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S FRY RD SUITE 285
KATY TX
77450-2256
US

IV. Provider business mailing address

9211 WEST RD SUITE 143-105
HOUSTON TX
77064-8633
US

V. Phone/Fax

Practice location:
  • Phone: 281-395-9966
  • Fax: 281-599-8596
Mailing address:
  • Phone: 281-395-9966
  • Fax: 281-599-8596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1427
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number1427
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1427
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number1427
License Number StateTX

VIII. Authorized Official

Name: DR. IWONA L CIBA
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 281-395-9966