Provider Demographics
NPI:1578640181
Name:MARIANO D CIBRAN, MD CORP DBA ST PETERSBURG PEDIATRICS
Entity Type:Organization
Organization Name:MARIANO D CIBRAN, MD CORP DBA ST PETERSBURG PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIANO
Authorized Official - Middle Name:D
Authorized Official - Last Name:CIBRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-526-9135
Mailing Address - Street 1:2115 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8815
Mailing Address - Country:US
Mailing Address - Phone:727-526-9135
Mailing Address - Fax:727-526-4346
Practice Address - Street 1:2115 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8815
Practice Address - Country:US
Practice Address - Phone:727-526-9135
Practice Address - Fax:727-526-4346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27935208000000X
363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33499OtherBLUE CROSS BLUE SHIELD
FL373318100Medicaid
FL373318108Medicaid
FL373318106Medicaid
FL373318107Medicaid
FL373318101Medicaid
FL373318102Medicaid
FL373318104Medicaid
FL373318105Medicaid
FL373318103Medicaid
FL373318102Medicaid
FL373318101Medicaid