Provider Demographics
NPI:1073027041
Name:IBARRA, IRMA S (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:S
Last Name:IBARRA
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2855
Mailing Address - Country:US
Mailing Address - Phone:888-417-5163
Mailing Address - Fax:
Practice Address - Street 1:2518 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2855
Practice Address - Country:US
Practice Address - Phone:888-417-5163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty