Provider Demographics
NPI:1861439093
Name:IRIBARREN, TERESA C (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:C
Last Name:IRIBARREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:C
Other - Last Name:IRIBARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD PA
Mailing Address - Street 1:12955 SW 42ND ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2902
Mailing Address - Country:US
Mailing Address - Phone:305-226-5106
Mailing Address - Fax:305-226-5105
Practice Address - Street 1:12955 SW 42ND ST
Practice Address - Street 2:SUITE 12
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2902
Practice Address - Country:US
Practice Address - Phone:305-226-5106
Practice Address - Fax:305-226-5105
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL79837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8267932OtherCIGNA
FL006M4OtherPREFERRED CARE PARTNERS
FL278113100Medicaid
FL170460OtherHUMANA
FL297125OtherAVMED
FL92269OtherBCBS FL
FL170460OtherHUMANA
FL8267932OtherCIGNA