Provider Demographics
NPI:1467004473
Name:IBANEZ, LUIS A (ARNP)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:IBANEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 HARLANO ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-7193
Mailing Address - Country:US
Mailing Address - Phone:786-367-2963
Mailing Address - Fax:
Practice Address - Street 1:7944 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4209
Practice Address - Country:US
Practice Address - Phone:305-261-2679
Practice Address - Fax:305-261-2859
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily