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General NPI Number Information
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NPI Number | 1194980011
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Entity Type | Individual
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Provider Name | CHERRYLL PHOEBE TARUC LIBED M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 10/10/2008
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Provider Practice Location Address
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Address Line | 4701 BRYANT IRVIN RD. N JPS VIOLA PITTS/COMO
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City | FORT WORTH
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State | TX
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Zip | 76107-4917
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Country | US
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Telephone | 817-920-7423
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Fax |
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Provider Business Mailing Address
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Address Line | 3016 NADAR
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City | GRAND PRAIRIE
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State | TX
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Zip | 75054-6792
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Country | US
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Telephone | 817-920-7423
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | N0924
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License Number State | TX
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