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NPI Code Detail

MEDICARE: IBIZA NEVARES, M.D. , P. A.

MEDICARE: IBIZA NEVARES, M.D. , P. A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician71574FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952608549
Entity Type Code : Organization
Provider Name (Legal Business Name) : IBIZA NEVARES, M.D. , P. A.
Provider Business Mailing Address
First Line : 7100 W COMMERCIAL BLVD
Second Line : SUITE 105
City : LAUDERHILL
State : FL
Zip : 33319-2155
Country : US
Telephone Number : 954-578-2292
Fax Number : 954-578-2330
Provider Business Practice Location Address
First Line : 7100 W COMMERCIAL BLVD
Second Line : SUITE 105
City : LAUDERHILL
State : FL
Zip : 33319-2155
Country : US
Telephone Number : 954-578-2292
Fax Number : 954-578-2330
Authorized Official
Title or Position : PRESIDENT
Name : DR. IBIZA NEVARES
Credential : M.D.
Telephone Number : 954-578-2292
Provider Enumeration Date : 02/17/2011
Last Update Date : 03/21/2011

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