Provider Demographics
NPI:1912960824
Name:NIVEA R RIBAS M D P A
Entity Type:Organization
Organization Name:NIVEA R RIBAS M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M D P A
Authorized Official - Prefix:
Authorized Official - First Name:NIVEA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIBAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-826-3931
Mailing Address - Street 1:5801 NW 151ST ST
Mailing Address - Street 2:STE 206
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2437
Mailing Address - Country:US
Mailing Address - Phone:305-826-3931
Mailing Address - Fax:305-826-5102
Practice Address - Street 1:5801 NW 151ST ST
Practice Address - Street 2:STE 206
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2437
Practice Address - Country:US
Practice Address - Phone:305-826-3931
Practice Address - Fax:305-826-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00644612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262443500Medicaid
FLDB1607OtherPALMETTO GBA
FL38524OtherBCBS GROUP #
FL38524OtherBCBS GROUP #