Provider Demographics
NPI:1952608549
Name:IBIZA NEVARES, M.D. , P. A.
Entity Type:Organization
Organization Name:IBIZA NEVARES, M.D. , P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IBIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-578-2292
Mailing Address - Street 1:7100 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2155
Mailing Address - Country:US
Mailing Address - Phone:954-578-2292
Mailing Address - Fax:954-578-2330
Practice Address - Street 1:7100 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2155
Practice Address - Country:US
Practice Address - Phone:954-578-2292
Practice Address - Fax:954-578-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL71574208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty