Provider Demographics
NPI:1437519311
Name:CARDONA-GIBOYEAUX, KIRIALIS IVETTE (OTL)
Entity type:Individual
Prefix:MISS
First Name:KIRIALIS
Middle Name:IVETTE
Last Name:CARDONA-GIBOYEAUX
Suffix:
Gender:F
Credentials:OTL
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Mailing Address - Street 1:J8 CALLE 7
Mailing Address - Street 2:URB. LA ESPERANZA
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-6800
Mailing Address - Country:US
Mailing Address - Phone:787-239-2401
Mailing Address - Fax:787-369-0992
Practice Address - Street 1:CARR 2 KM 39.9 BO. ALGARROBO
Practice Address - Street 2:SUITE 105 CENTRO COMERCIAL PLAZA JARDINES
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-654-6493
Practice Address - Fax:787-369-0992
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR1245225X00000X, 225XP0019X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics