Provider Demographics
NPI:1750872339
Name:BARBOSA IGLESIAS, GLEIBYS
Entity type:Individual
Prefix:
First Name:GLEIBYS
Middle Name:
Last Name:BARBOSA IGLESIAS
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 1:5921 SW 9TH TER
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5016
Mailing Address - Country:US
Mailing Address - Phone:786-532-5410
Mailing Address - Fax:
Practice Address - Street 1:5921 SW 9TH TER
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144
Practice Address - Country:US
Practice Address - Phone:786-532-5410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-19
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
FL022607300103K00000X, 106S00000X
FLB612-280-81-763-0103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022607300Medicaid
FL$$$$$$$$$OtherSOCIAL SECURITY