Provider Demographics
NPI:1639879323
Name:IBANEZ AGUILAR, MIRELYS (BCBA)
Entity type:Individual
Prefix:
First Name:MIRELYS
Middle Name:
Last Name:IBANEZ AGUILAR
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10073 SW 157TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6141
Mailing Address - Country:US
Mailing Address - Phone:305-721-6695
Mailing Address - Fax:
Practice Address - Street 1:10073 SW 157TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-6141
Practice Address - Country:US
Practice Address - Phone:305-721-6695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-25-79243103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst