Healthcare Provider Details

I. General information

NPI: 1104490655
Provider Name (Legal Business Name): BRENDA IRIBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 03/14/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2677 FOREST HILL BLVD STE 109
WEST PALM BEACH FL
33406-5941
US

IV. Provider business mailing address

1564 W 34TH ST
RIVIERA BEACH FL
33404-2912
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-5050
  • Fax:
Mailing address:
  • Phone: 561-508-0654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: