Provider Demographics
NPI:1285675520
Name:MARIBONA, JAVIER FRANCISCO (DPM)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:FRANCISCO
Last Name:MARIBONA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 SW 58TH CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-2326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8582 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3214
Practice Address - Country:US
Practice Address - Phone:305-551-3412
Practice Address - Fax:395-551-1945
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2126213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053767500Medicaid
FL65155Medicare ID - Type Unspecified
FL053767500Medicaid