Provider Demographics
NPI:1649292194
Name:LIMA-MARIBONA, JANICE (DO)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:LIMA-MARIBONA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 BIRD ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33146
Mailing Address - Country:US
Mailing Address - Phone:305-669-8337
Mailing Address - Fax:305-856-4883
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:1005
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:305-856-7887
Practice Address - Fax:305-856-0805
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS0006885207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG03430Medicare UPIN