Provider Demographics
NPI:1225230071
Name:SIBRAVA, TANYA JANETTE (DO)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:JANETTE
Last Name:SIBRAVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:JANETTE
Other - Last Name:HONZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:161 E RIVULON BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0087
Mailing Address - Country:US
Mailing Address - Phone:480-494-2465
Mailing Address - Fax:
Practice Address - Street 1:161 E RIVULON BLVD STE 210
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0087
Practice Address - Country:US
Practice Address - Phone:480-494-2465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4653207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ219206-01Medicaid
AZFH0338714OtherDEA
AZFH0338714OtherDEA
AZZ115842Medicare PIN
AZP00438833Medicare PIN