Provider Demographics
NPI:1689249062
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:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCPHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
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:
Practice Address - Street 1:3475 E BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-5905
Practice Address - Country:US
Practice Address - Phone:727-535-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIANO CIBRAN, MD CORP DBA ST PETERSBURG PEDIATRICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373318105Medicaid