Provider Demographics
NPI:1174846885
Name:IBANEZ, LOURDES M
Entity Type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:M
Last Name:IBANEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5921 BELLAIRE BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5524
Mailing Address - Country:US
Mailing Address - Phone:713-432-7212
Mailing Address - Fax:713-432-1503
Practice Address - Street 1:5921 BELLAIRE BLVD
Practice Address - Street 2:STE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5524
Practice Address - Country:US
Practice Address - Phone:713-432-7212
Practice Address - Fax:713-432-1503
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management