Provider Demographics
NPI:1093492282
Name:RIBEIRO, CHARLYNE ANN
Entity Type:Individual
Prefix:
First Name:CHARLYNE
Middle Name:ANN
Last Name:RIBEIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4768
Mailing Address - Country:US
Mailing Address - Phone:619-635-0617
Mailing Address - Fax:
Practice Address - Street 1:286 EUCLID AVE STE 104
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-3611
Practice Address - Country:US
Practice Address - Phone:619-859-6270
Practice Address - Fax:619-266-0496
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist