Provider Demographics
NPI:1518070432
Name:MATEO-BIBEAU, ANA RAQUEL (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:RAQUEL
Last Name:MATEO-BIBEAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10115 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3105
Mailing Address - Country:US
Mailing Address - Phone:561-967-0101
Mailing Address - Fax:561-967-6260
Practice Address - Street 1:5401 S CONGRESS AVE STE 201
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6637
Practice Address - Country:US
Practice Address - Phone:561-967-0101
Practice Address - Fax:561-967-6260
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93929207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273710800Medicaid
FL273710800Medicaid
U5986YMedicare PIN