Healthcare Provider Details

I. General information

NPI: 1881019636
Provider Name (Legal Business Name): IGNACIO R BARBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 W 16TH AVE SUITE 250
HIALEAH FL
33012-7189
US

IV. Provider business mailing address

4445 W 16TH AVE SUITE 250
HIALEAH FL
33012-7189
US

V. Phone/Fax

Practice location:
  • Phone: 305-826-4570
  • Fax: 305-827-1404
Mailing address:
  • Phone: 305-826-4570
  • Fax: 305-827-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberCRT38688
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: