Healthcare Provider Details

I. General information

NPI: 1497160634
Provider Name (Legal Business Name): MS. SUSANA IBANEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 SW 40TH ST # 471
MIAMI FL
33155-3708
US

IV. Provider business mailing address

6800 SW 40TH ST # 471
MIAMI FL
33155-3708
US

V. Phone/Fax

Practice location:
  • Phone: 786-444-0434
  • Fax:
Mailing address:
  • Phone: 786-444-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT15689
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: