Provider Demographics
NPI:1952514515
Name:PENA-GARCIA, IBIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:IBIS
Middle Name:
Last Name:PENA-GARCIA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8405 NW 53RD ST
Mailing Address - Street 2:SUITE#A108
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4523
Mailing Address - Country:US
Mailing Address - Phone:305-599-2111
Mailing Address - Fax:305-599-2233
Practice Address - Street 1:8405 NW 53RD ST
Practice Address - Street 2:SUITE#A108
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-4523
Practice Address - Country:US
Practice Address - Phone:305-599-2111
Practice Address - Fax:305-599-2233
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 3842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75888Medicare ID - Type UnspecifiedPROVIDER NUMBER