Provider Demographics
NPI:1114247855
Name:IBARRA, JESSICA B (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:B
Last Name:IBARRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LA MILAGROSA B6 URB GARCIA PONCE
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00380
Mailing Address - Country:US
Mailing Address - Phone:787-447-9711
Mailing Address - Fax:
Practice Address - Street 1:AVE. PONCE DE LEON TORRE MEDICA AUXILIO MUTUO SUITE 815
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-936-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17206146D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant