Provider Demographics
NPI:1689625766
Name:GUIRIBITEY, AVELINO A (MD)
Entity Type:Individual
Prefix:
First Name:AVELINO
Middle Name:A
Last Name:GUIRIBITEY
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 1:4445 W 16TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7190
Mailing Address - Country:US
Mailing Address - Phone:305-826-5887
Mailing Address - Fax:305-362-1559
Practice Address - Street 1:4445 W 16TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7190
Practice Address - Country:US
Practice Address - Phone:305-826-5887
Practice Address - Fax:305-362-1559
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0066054207N00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374992400Medicaid
FL374992400Medicaid
FL25102Medicare ID - Type Unspecified