Provider Demographics
NPI:1609334291
Name:IBANEZ, YUSLEYDIS
Entity Type:Individual
Prefix:
First Name:YUSLEYDIS
Middle Name:
Last Name:IBANEZ
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 1:1920 NW 107TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167-3814
Mailing Address - Country:US
Mailing Address - Phone:786-238-7969
Mailing Address - Fax:305-400-2430
Practice Address - Street 1:1920 NW 107TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33167-3814
Practice Address - Country:US
Practice Address - Phone:786-238-7969
Practice Address - Fax:305-400-2430
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9436668163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse