Provider Demographics
NPI:1275947970
Name:IBARRA, JORGE
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
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 1:10711 BEXLEY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-1803
Mailing Address - Country:US
Mailing Address - Phone:281-857-3781
Mailing Address - Fax:281-564-5694
Practice Address - Street 1:10711 BEXLEY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-1803
Practice Address - Country:US
Practice Address - Phone:281-857-3781
Practice Address - Fax:281-564-5694
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist