Provider Demographics
NPI:1689897753
Name:RIBADENEYRA, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:RIBADENEYRA
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 1:1804 E PAVILION PL UNIT A
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5795
Mailing Address - Country:US
Mailing Address - Phone:786-351-3093
Mailing Address - Fax:
Practice Address - Street 1:1804 E PAVILION PL UNIT A
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5795
Practice Address - Country:US
Practice Address - Phone:970-249-6670
Practice Address - Fax:970-252-1372
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09410400207Q00000X
CODR0057738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine