MEDICARE: MARIA JOSE ILABACA RIVERA LM, RN

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	163W00000X	Registered Nurse	9595220	FL
2	163WL0100X	Lactation Consultant (Registered Nurse)	9595220	FL
3	163WM0102X	Maternal Newborn Registered Nurse	9595220	FL
4	163WN0003X	Low-Risk Neonatal Registered Nurse	9595220	FL
5	163WP1700X	Perinatal Registered Nurse	9595220	FL
6	163WW0101X	Ambulatory Women's Health Care Registered Nurse	9595220	FL
7	163WX0003X	Inpatient Obstetric Registered Nurse	9595220	FL
8	176B00000X	Midwife	445	FL

General Provider Information

NPI Number	:	1689481285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA JOSE ILABACA RIVERA LM, RN

Provider Business Mailing Address
First Line	:	520 BRICKELL KEY DR APT 1512
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-2660
Country	:	US
Telephone Number	:	305-924-4031
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 BRICKELL KEY DR APT 1512
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-2660
Country	:	US
Telephone Number	:	305-924-4031
Fax Number	:

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

Provider Enumeration Date	:	12/17/2024
Last Update Date	:	12/17/2024

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