Provider Demographics
NPI:1518388149
Name:RIBO, MIGUEL A SR (CSA)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:RIBO
Suffix:SR
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6912 N THATCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3823
Mailing Address - Country:US
Mailing Address - Phone:813-453-8872
Mailing Address - Fax:
Practice Address - Street 1:6912 N THATCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3823
Practice Address - Country:US
Practice Address - Phone:813-453-8872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13-427246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9526900855Medicaid