Provider Demographics
NPI:1659340693
Name:NEVARES, IBIZA (MD)
Entity Type:Individual
Prefix:
First Name:IBIZA
Middle Name:
Last Name:NEVARES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319
Mailing Address - Country:US
Mailing Address - Phone:954-578-2292
Mailing Address - Fax:954-578-2330
Practice Address - Street 1:7100 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319
Practice Address - Country:US
Practice Address - Phone:954-578-2292
Practice Address - Fax:954-578-2330
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71574208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263726OtherAMED
FL263797900Medicaid
FL41618AOtherBCBS
FL263797900Medicaid
FL41618AOtherBCBS