Provider Demographics
NPI:1487736856
Name:PINILLA-IBARZ, JAVIER A (MD)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:A
Last Name:PINILLA-IBARZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12902 MAGNOLIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7770
Mailing Address - Country:US
Mailing Address - Phone:813-745-4748
Mailing Address - Fax:813-745-6817
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:MRC 3 EAST RM 3056H
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:813-745-4748
Practice Address - Fax:813-745-6817
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97234207R00000X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68994OtherBLUE CROSS BLUE SHIELD
FL276825900Medicaid
FLI64387Medicare UPIN
FL276825900Medicaid
FL68994OtherBLUE CROSS BLUE SHIELD