Provider Demographics
NPI:1780642496
Name:HERIBA, HAYAT M (MD)
Entity Type:Individual
Prefix:
First Name:HAYAT
Middle Name:M
Last Name:HERIBA
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 1:3328 E SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6003
Mailing Address - Country:US
Mailing Address - Phone:407-869-6661
Mailing Address - Fax:407-869-6226
Practice Address - Street 1:3328 E SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6003
Practice Address - Country:US
Practice Address - Phone:407-869-6661
Practice Address - Fax:407-869-6226
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055867200Medicaid
FLE66209Medicare UPIN
FL10735OMedicare PIN
FL10735OMedicare ID - Type Unspecified