Provider Demographics
NPI:1689686933
Name:CHIBAS, MARISEL R (MD)
Entity Type:Individual
Prefix:
First Name:MARISEL
Middle Name:R
Last Name:CHIBAS
Suffix:
Gender:F
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:PO BOX 440
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-0440
Mailing Address - Country:US
Mailing Address - Phone:760-352-6868
Mailing Address - Fax:760-560-4626
Practice Address - Street 1:1271 ROSS AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4304
Practice Address - Country:US
Practice Address - Phone:760-352-6868
Practice Address - Fax:760-560-4626
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85381207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A853810Medicaid
CA1689686933OtherNATIONAL PROVIDER NUMBER
CA00A853810Medicaid