Provider Demographics
NPI:1114705522
Name:DIBIASE, CHRISTIAN PAUL (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:PAUL
Last Name:DIBIASE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SANS SOUCI BLVD APT 207
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3053
Mailing Address - Country:US
Mailing Address - Phone:518-852-7939
Mailing Address - Fax:
Practice Address - Street 1:1900 SANS SOUCI BLVD APT 207
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3053
Practice Address - Country:US
Practice Address - Phone:518-852-7939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant