Provider Demographics
NPI:1366995805
Name:IGLESIAS CARDET, INES M
Entity type:Individual
Prefix:
First Name:INES
Middle Name:M
Last Name:IGLESIAS CARDET
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 1:204 TRUMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-1814
Mailing Address - Country:US
Mailing Address - Phone:786-328-6394
Mailing Address - Fax:786-219-3320
Practice Address - Street 1:204 TRUMAN AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-1814
Practice Address - Country:US
Practice Address - Phone:786-328-6394
Practice Address - Fax:786-219-3320
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013948600Medicaid
FLRBT-16-14815OtherRBT