Provider Demographics
NPI:1326112244
Name:MALIBIRAN, ROLANDO M (MD)
Entity Type:Individual
Prefix:
First Name:ROLANDO
Middle Name:M
Last Name:MALIBIRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 COUNTY ROAD 44 LEG A
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3704
Mailing Address - Country:US
Mailing Address - Phone:352-728-5126
Mailing Address - Fax:352-323-8865
Practice Address - Street 1:8110 COUNTY ROAD 44 LEG A
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3704
Practice Address - Country:US
Practice Address - Phone:352-728-5126
Practice Address - Fax:352-323-8865
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30159174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35198YMedicare ID - Type Unspecified
FLD54360Medicare UPIN