Provider Demographics
NPI:1194372227
Name:LARIBEE, MATTHEW ZACHARY (CAA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ZACHARY
Last Name:LARIBEE
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SW 148TH AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-3081
Mailing Address - Country:US
Mailing Address - Phone:860-378-4082
Mailing Address - Fax:
Practice Address - Street 1:7900 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7457
Practice Address - Country:US
Practice Address - Phone:860-378-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL534367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant