Provider Demographics
NPI:1376566323
Name:IBARRA, RODOLFO (MD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:IBARRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3816 WOODRUFF AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2145
Mailing Address - Country:US
Mailing Address - Phone:562-423-0436
Mailing Address - Fax:562-394-9272
Practice Address - Street 1:3816 WOODRUFF AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2147
Practice Address - Country:US
Practice Address - Phone:562-423-0436
Practice Address - Fax:562-394-9272
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG57516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F06228Medicare UPIN