# IBANEZ CLINICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ibanez Clinical Group LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821805938
- **Authorized official:** GISELLE IBANEZ (MNGR)
- **Authorized official phone:** (786) 422-4643

## Contact information

- **Practice address:** 1701 PONCE DE LEON BLVD STE 305, CORAL GABLES, FL 33134-4484
- **Practice address phone:** (786) 422-4636
- **Mailing address:** 1701 PONCE DE LEON BLVD STE 305, CORAL GABLES, FL 33134-4484
- **Mailing address phone:** (786) 422-4636

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/12/2024
- **Last updated:** 12/12/2024