Provider Demographics
NPI:1558025114
Name:IBARRA, DIANA A
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:A
Last Name:IBARRA
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 1:2904 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1870
Mailing Address - Country:US
Mailing Address - Phone:956-631-8646
Mailing Address - Fax:956-631-8650
Practice Address - Street 1:1010 S AIRPORT DR STE B
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6650
Practice Address - Country:US
Practice Address - Phone:956-375-2045
Practice Address - Fax:956-375-2046
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210017224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant