Provider Demographics
NPI:1366693111
Name:IBARRA, DANILO (LMT)
Entity Type:Individual
Prefix:
First Name:DANILO
Middle Name:
Last Name:IBARRA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 NE 26TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1431
Mailing Address - Country:US
Mailing Address - Phone:954-564-6573
Mailing Address - Fax:954-564-6513
Practice Address - Street 1:1650 NE 26TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1431
Practice Address - Country:US
Practice Address - Phone:954-564-6573
Practice Address - Fax:954-564-6513
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52106172V00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No172V00000XOther Service ProvidersCommunity Health Worker