Provider Demographics
NPI:1154193068
Name:PANDO, ANA IBIS
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:IBIS
Last Name:PANDO
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 1:7943 W 2ND CT APT 101
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4380
Mailing Address - Country:US
Mailing Address - Phone:305-646-8960
Mailing Address - Fax:
Practice Address - Street 1:1380 NE MIAMI GARDENS DR STE 220F
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4720
Practice Address - Country:US
Practice Address - Phone:786-523-3249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-304634106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician