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General NPI Number Information
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NPI Number | 1790651917
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Entity Type | Individual
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Provider Name | IVAN ERNESTO KIDD BARALT SA-C
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Gender | Male
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Dates
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Enumeration Date | 10/14/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 145 SW 8TH ST UNIT 2101
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City | MIAMI
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State | FL
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Zip | 33130-3664
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Country | US
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Telephone | 305-322-7894
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Fax | 305-322-7894
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Provider Business Mailing Address
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Address Line | 145 SW 8TH ST UNIT 2101
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City | MIAMI
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State | FL
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Zip | 33130-3664
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Country | US
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Telephone | 305-322-7894
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Fax | 305-322-7894
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2832-P.A.
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 20-190
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License Number State | FL
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