Provider Demographics
NPI:1184206518
Name:IBARRA, RAMON DANIEL
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:DANIEL
Last Name:IBARRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1032 OPUKU ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2772
Mailing Address - Country:US
Mailing Address - Phone:619-507-7677
Mailing Address - Fax:
Practice Address - Street 1:1253 MAKALAPA ROAD
Practice Address - Street 2:
Practice Address - City:HICKAM
Practice Address - State:HI
Practice Address - Zip Code:96853
Practice Address - Country:US
Practice Address - Phone:808-473-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)