Provider Demographics
NPI:1013633510
Name:MAS IBANEZ, JORGE ULPIANO
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ULPIANO
Last Name:MAS IBANEZ
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 1:7420 BIG CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2557
Mailing Address - Country:US
Mailing Address - Phone:305-613-7703
Mailing Address - Fax:
Practice Address - Street 1:7420 BIG CYPRESS DR
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2557
Practice Address - Country:US
Practice Address - Phone:305-613-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide