1952608549 NPI number — IBIZA NEVARES, M.D. , P. A.

Table of content: (NPI 1952608549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952608549 NPI number — IBIZA NEVARES, M.D. , P. A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IBIZA NEVARES, M.D. , P. A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952608549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7100 W COMMERCIAL BLVD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
LAUDERHILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33319-2155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-578-2292
Provider Business Mailing Address Fax Number:
954-578-2330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7100 W COMMERCIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
LAUDERHILL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33319-2155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-578-2292
Provider Business Practice Location Address Fax Number:
954-578-2330
Provider Enumeration Date:
02/17/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEVARES
Authorized Official First Name:
IBIZA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-578-2292

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  71574 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)