Provider Demographics
NPI:1205470838
Name:HAITO TRIBADOS, PAULA M (ATC)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:HAITO TRIBADOS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 NW 114TH AVE UNIT 1P
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33192-4177
Mailing Address - Country:US
Mailing Address - Phone:786-664-3640
Mailing Address - Fax:
Practice Address - Street 1:CALLE 64 OESTE
Practice Address - Street 2:
Practice Address - City:PANAMA
Practice Address - State:PANAMA
Practice Address - Zip Code:00507
Practice Address - Country:PA
Practice Address - Phone:507-236-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1204020062081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty