Provider Demographics
NPI:1477964195
Name:BACHOVE, INESSA RACHEL (DO)
Entity Type:Individual
Prefix:
First Name:INESSA
Middle Name:RACHEL
Last Name:BACHOVE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:INESSA
Other - Middle Name:RACHEL
Other - Last Name:SIMANOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11880 SW 40TH ST STE 304
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3574
Mailing Address - Country:US
Mailing Address - Phone:305-223-8808
Mailing Address - Fax:305-223-8974
Practice Address - Street 1:3365 BURNS RD STE 206
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4303
Practice Address - Country:US
Practice Address - Phone:561-227-1456
Practice Address - Fax:561-775-7980
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05017039207K00000X, 208000000X
FLOS13953208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019478700Medicaid