Provider Demographics
NPI:1659116671
Name:IVONNET GALBAN, RICARDO ANTONIO
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:ANTONIO
Last Name:IVONNET GALBAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12934 SW 285TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1997
Mailing Address - Country:US
Mailing Address - Phone:786-539-6221
Mailing Address - Fax:
Practice Address - Street 1:900 SW 97TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2935
Practice Address - Country:US
Practice Address - Phone:786-539-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine