Provider Demographics
NPI:1477160802
Name:IBARRA, JUAN C
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:C
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 1:423 CHAMPIONS DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8935
Mailing Address - Country:US
Mailing Address - Phone:956-459-7266
Mailing Address - Fax:
Practice Address - Street 1:423 CHAMPIONS DR
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8935
Practice Address - Country:US
Practice Address - Phone:956-459-7266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health