Active NPI
Vivian Karina Ibanez
- Specialist
- East Boston, MA
National Provider Identifier
1174907588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 042317215
- Practice address
- 130 Condor Street
East Boston, MA 02128 - Phone
- (617) 569-6560
- NPI assigned
- Jul 15, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 042317215 | MA | Primary |
Addresses
Primary practice location
130 Condor Street
East Boston, MA 02128
Mailing address
31 Ware St.
Dedham, MA 02026
Phone (617) 838-7287
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436918400000",
"number": "1174907588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 WARE ST.",
"city": "DEDHAM",
"state": "MA",
"postal_code": "02026",
"telephone_number": "617-838-7287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 CONDOR STREET",
"city": "EAST BOSTON",
"state": "MA",
"postal_code": "02128",
"telephone_number": "617-569-6560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBANEZ",
"first_name": "VIVIAN",
"middle_name": "KARINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-15",
"last_updated": "2015-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MA",
"license": "042317215",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.