Provider Demographics
NPI:1093996019
Name:MALIBIRAN, LIEZL (CNP)
Entity Type:Individual
Prefix:
First Name:LIEZL
Middle Name:
Last Name:MALIBIRAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5076
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44061-5076
Mailing Address - Country:US
Mailing Address - Phone:440-350-4747
Mailing Address - Fax:440-350-4747
Practice Address - Street 1:8386 RALEIGH PL
Practice Address - Street 2:
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-8546
Practice Address - Country:US
Practice Address - Phone:440-709-6028
Practice Address - Fax:440-709-6303
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP09561363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0099265Medicaid
OH0099265Medicaid