=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023189776
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARIBEL MEDICAL SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 138 NE 1ST AVE
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-4204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-319-8123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 138 NE 1ST AVE
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-4204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-319-8123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARIBEL GARCIA MORENO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-319-8123
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------