Provider Demographics
NPI:1487236808
Name:MORO IRIBAR, ANNIEYIS
Entity type:Individual
Prefix:
First Name:ANNIEYIS
Middle Name:
Last Name:MORO IRIBAR
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 1:7010 NW 179TH ST APT 202
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5410
Mailing Address - Country:US
Mailing Address - Phone:786-370-7436
Mailing Address - Fax:
Practice Address - Street 1:7010 NW 179TH ST APT 202
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5410
Practice Address - Country:US
Practice Address - Phone:786-370-7436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-157497106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician