Provider Demographics
NPI:1750431821
Name:KIBA MEDICAL CORP
Entity type:Organization
Organization Name:KIBA MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-261-8010
Mailing Address - Street 1:7815 CORAL WAY
Mailing Address - Street 2:STE105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6541
Mailing Address - Country:US
Mailing Address - Phone:305-261-8010
Mailing Address - Fax:305-262-9418
Practice Address - Street 1:7815 CORAL WAY
Practice Address - Street 2:STE105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6541
Practice Address - Country:US
Practice Address - Phone:305-261-8010
Practice Address - Fax:305-262-9418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3992261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39332Medicare PIN