Healthcare Provider Details

I. General information

NPI: 1013593441
Provider Name (Legal Business Name): IBIS FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4574 SAN FRATELLO CIR
LAKE WORTH FL
33467-5074
US

IV. Provider business mailing address

4736 LAGO VISTA DR
COCONUT CREEK FL
33073-4930
US

V. Phone/Fax

Practice location:
  • Phone: 954-901-0616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT15624
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: