MEDICARE: MS. SUSANA IBANEZ

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
1	227800000X	Certified Respiratory Therapist	TT15689	FL

General Provider Information

NPI Number	:	1497160634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSANA IBANEZ

Provider Business Mailing Address
First Line	:	6800 SW 40TH ST # 471
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-3708
Country	:	US
Telephone Number	:	786-444-0434
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 SW 40TH ST # 471
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-3708
Country	:	US
Telephone Number	:	786-444-0434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2014
Last Update Date	:	06/26/2014

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Directions to “ MS. SUSANA IBANEZ ” Practice Location

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