Provider Demographics
NPI:1477387140
Name:SIMON CHIBAS, NITZA BARBARA
Entity type:Individual
Prefix:
First Name:NITZA
Middle Name:BARBARA
Last Name:SIMON CHIBAS
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 1:11057 SW 152ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-4512
Mailing Address - Country:US
Mailing Address - Phone:786-978-8968
Mailing Address - Fax:
Practice Address - Street 1:6800 NW 169TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4210
Practice Address - Country:US
Practice Address - Phone:786-615-8426
Practice Address - Fax:786-801-1724
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ12164235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty