Provider Demographics
NPI:1780032698
Name:PINEY IBARRA, VICTOR M
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
Last Name:PINEY IBARRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 SW 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3101
Mailing Address - Country:US
Mailing Address - Phone:305-794-5093
Mailing Address - Fax:
Practice Address - Street 1:12855 SW 132ND ST
Practice Address - Street 2:SUITE 207
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7207
Practice Address - Country:US
Practice Address - Phone:786-587-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician