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NPI Code Detail

MEDICARE: MR. KEVIN GUILLERMO IBARRA

MEDICARE: MR. KEVIN GUILLERMO IBARRA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1013843283
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN GUILLERMO IBARRA
Provider Business Mailing Address
First Line : 8001 SW 36TH ST STE 9
Second Line :
City : DAVIE
State : FL
Zip : 33328-1915
Country : US
Telephone Number : 954-577-7790
Fax Number : 954-577-7780
Provider Business Practice Location Address
First Line : 8001 SW 36TH ST STE 9
Second Line :
City : DAVIE
State : FL
Zip : 33328-1915
Country : US
Telephone Number : 954-577-7790
Fax Number : 954-577-7780
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2026
Last Update Date : 06/23/2026

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Directions to “ MR. KEVIN GUILLERMO IBARRA ” Practice Location

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