Provider Demographics
NPI:1356992135
Name:IBANEZ, ANGEL IGNACIO
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:IGNACIO
Last Name: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 1:3809 SULLIVAN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2366
Mailing Address - Country:US
Mailing Address - Phone:256-325-1774
Mailing Address - Fax:
Practice Address - Street 1:809 US HIGHWAY 72 W
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-4236
Practice Address - Country:US
Practice Address - Phone:256-233-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2305237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty