Provider Demographics
NPI:1154914760
Name:FIGUEROA, IVAN DANIEL
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:DANIEL
Last Name:FIGUEROA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 SW 141ST ST APT M8
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7250
Mailing Address - Country:US
Mailing Address - Phone:305-318-1730
Mailing Address - Fax:
Practice Address - Street 1:8701 SW 141ST ST APT M8
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7250
Practice Address - Country:US
Practice Address - Phone:305-318-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician