Provider Demographics
NPI:1063481331
Name:IBARRA, JOSE L (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:IBARRA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5561 E KINGS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-4528
Mailing Address - Country:US
Mailing Address - Phone:559-255-0496
Mailing Address - Fax:559-253-0510
Practice Address - Street 1:5561 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4528
Practice Address - Country:US
Practice Address - Phone:559-255-0496
Practice Address - Fax:559-253-0510
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG73482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G734820Medicare PIN
CAE76803Medicare UPIN