Provider Demographics
NPI:1053722751
Name:MARYANN DILIBERO, OD
Entity type:Organization
Organization Name:MARYANN DILIBERO, OD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DILIBERO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-351-9344
Mailing Address - Street 1:1729 PABLO PL
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-1210
Mailing Address - Country:US
Mailing Address - Phone:775-351-9344
Mailing Address - Fax:
Practice Address - Street 1:1729 PABLO PL
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-1210
Practice Address - Country:US
Practice Address - Phone:775-351-9344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8404T261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center