Provider Demographics
NPI:1790060697
Name:RIBAS, MICHELLE DULUDE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DULUDE
Last Name:RIBAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ZENAIDA
Other - Last Name:DULUDE RIBAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:921 OAK PARK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3400
Mailing Address - Country:US
Mailing Address - Phone:805-546-0411
Mailing Address - Fax:805-473-4891
Practice Address - Street 1:292 POSADA LN STE C
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4054
Practice Address - Country:US
Practice Address - Phone:805-434-2253
Practice Address - Fax:805-434-3850
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116654208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB217834Medicare PIN
CACB217833Medicare PIN