Provider Demographics
NPI:1144299124
Name:RIBO, ANGEL I (PA)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:I
Last Name:RIBO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 N LAKEWALK DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-1304
Mailing Address - Country:US
Mailing Address - Phone:903-445-9363
Mailing Address - Fax:833-490-1306
Practice Address - Street 1:240 N FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3400
Practice Address - Country:US
Practice Address - Phone:386-255-5569
Practice Address - Fax:386-256-4730
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105286207R00000X, 261QC1500X, 261QP2300X, 363AM0700X, 207RI0200X
TXPA02326363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS82298Medicare UPIN