Healthcare Provider Details

I. General information

NPI: 1912285768
Provider Name (Legal Business Name): IVIS PINEIRO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170WEST 60TH STREET APT#16110
HIALEAH FL
33016
US

IV. Provider business mailing address

2170WEST 60TH STREET APT#16110
HIALEAH FL
33016
US

V. Phone/Fax

Practice location:
  • Phone: 786-426-0119
  • Fax:
Mailing address:
  • Phone: 786-426-0119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberMA54108
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: