Provider Demographics
NPI:1871866848
Name:RIBAO, CHRISTINA MARINA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARINA
Last Name:RIBAO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 S DENISON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-6703
Mailing Address - Country:US
Mailing Address - Phone:323-379-3611
Mailing Address - Fax:786-629-6142
Practice Address - Street 1:3031 S DENISON AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-6703
Practice Address - Country:US
Practice Address - Phone:323-379-3611
Practice Address - Fax:786-629-6142
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106450363AS0400X
CAPA54712363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical