Provider Demographics
NPI:1689481285
Name:ILABACA RIVERA, MARIA JOSE (LM, RN)
Entity type:Individual
Prefix:
First Name:MARIA JOSE
Middle Name:
Last Name:ILABACA RIVERA
Suffix:
Gender:F
Credentials:LM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 BRICKELL KEY DR APT 1512
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2660
Mailing Address - Country:US
Mailing Address - Phone:305-924-4031
Mailing Address - Fax:
Practice Address - Street 1:520 BRICKELL KEY DR APT 1512
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2660
Practice Address - Country:US
Practice Address - Phone:305-924-4031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9595220163W00000X, 163WL0100X, 163WM0102X, 163WN0003X, 163WP1700X, 163WW0101X, 163WX0003X
FL445176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient