Provider Demographics
NPI:1356183222
Name:OSTROVA, IANA
Entity type:Individual
Prefix:
First Name:IANA
Middle Name:
Last Name:OSTROVA
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 1:2200 S OCEAN DR APT 205
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2546
Mailing Address - Country:US
Mailing Address - Phone:786-658-9265
Mailing Address - Fax:305-402-8554
Practice Address - Street 1:3911 SW56TH CT
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312
Practice Address - Country:US
Practice Address - Phone:305-988-5115
Practice Address - Fax:305-402-8554
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician