Provider Demographics
NPI:1699876680
Name:RIBOUL, TAMARA MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:MICHELLE
Last Name:RIBOUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URBANIZACION COLINAS DE CUPEY
Mailing Address - Street 2:STREET 5 #D-21
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-755-0112
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA ARBOLOTE #1 PLAZA REAL SHOPPING CENTER
Practice Address - Street 2:SUITE #307
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-247-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16437208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics