Individual
VIVIAN KARINA IBANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
130 CONDOR STREET, EAST BOSTON, MA 02128
(617) 569-6560
Mailing address
31 WARE ST., DEDHAM, MA 02026
(617) 838-7287
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
042317215
MA
Other
Enumeration date
07/15/2015
Last updated
07/15/2015
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