Provider Demographics
NPI:1376717918
Name:FISBOIN, EVELYN
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:
Last Name:FISBOIN
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 1:19300 W DIXIE HWY
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2201
Mailing Address - Country:US
Mailing Address - Phone:305-936-8960
Mailing Address - Fax:305-936-8961
Practice Address - Street 1:19300 W DIXIE HWY
Practice Address - Street 2:SUITE #2
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-2201
Practice Address - Country:US
Practice Address - Phone:305-936-8960
Practice Address - Fax:305-936-8961
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program