=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326203647
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TORIBIO MEDICAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2008
-----------------------------------------------------
Last Update Date | 03/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8001 N DALE MABRY HWY STE 601
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33614-3290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-886-0713
-----------------------------------------------------
Fax | 813-881-1848
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6301 MEMORIAL HWY SUITE 104
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33615-4573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-886-0713
-----------------------------------------------------
Fax | 813-881-1848
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. FIORDALIZA TORIBIO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 813-886-0713
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME 88065
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------