Provider Demographics
NPI:1043269152
Name:CIBA, IWONA L (DPM)
Entity type:Individual
Prefix:DR
First Name:IWONA
Middle Name:L
Last Name:CIBA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9211 WEST RD
Mailing Address - Street 2:SUITE 143-105
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-8633
Mailing Address - Country:US
Mailing Address - Phone:281-395-9966
Mailing Address - Fax:281-599-8596
Practice Address - Street 1:25722 KINGSLAND BLVD
Practice Address - Street 2:STE 201B
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6705
Practice Address - Country:US
Practice Address - Phone:281-395-9966
Practice Address - Fax:281-599-8596
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1427213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018589401Medicaid
TX00445EMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TX018589401Medicaid