Provider Demographics
NPI:1326773177
Name:CHIRINO, IVANIA
Entity Type:Individual
Prefix:
First Name:IVANIA
Middle Name:
Last Name:CHIRINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2985 W 80TH ST APT 228
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-3839
Mailing Address - Country:US
Mailing Address - Phone:786-241-6173
Mailing Address - Fax:
Practice Address - Street 1:2985 W 80TH ST APT 228
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-3839
Practice Address - Country:US
Practice Address - Phone:786-241-6173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA81290225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist