Provider Demographics
NPI:1245344498
Name:AVELINO A GUIRIBITEY MD PA
Entity type:Organization
Organization Name:AVELINO A GUIRIBITEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AVELINO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUIRIBITEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-826-5887
Mailing Address - Street 1:4445 W 16TH AVE STE 300
Mailing Address - Street 2:3990 WEST FLAGLER STREET SUITE 103 MIAMI FL 33134
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7190
Mailing Address - Country:US
Mailing Address - Phone:305-826-5887
Mailing Address - Fax:305-362-1559
Practice Address - Street 1:4445 W 16TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7190
Practice Address - Country:US
Practice Address - Phone:305-826-5887
Practice Address - Fax:305-362-1559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0066054208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374992400Medicaid
FL25102Medicare ID - Type Unspecified
FLF80412Medicare UPIN