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NPI Code Detail

MEDICARE: VIVIAN IBANEZ M.A., BCBA

MEDICARE: VIVIAN IBANEZ M.A., BCBA
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
1103K00000XBehavior Analyst1-15-19872FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205209038
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIVIAN IBANEZ M.A., BCBA
Provider Business Mailing Address
First Line : PO BOX 100256
Second Line :
City : GAINESVILLE
State : FL
Zip : 32610-0256
Country : US
Telephone Number : 352-265-4357
Fax Number : 352-392-3614
Provider Business Practice Location Address
First Line : 1015 NW 56TH TER
Second Line :
City : GAINESVILLE
State : FL
Zip : 32605-4481
Country : US
Telephone Number : 352-835-5520
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2015
Last Update Date : 08/12/2019

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