Provider Demographics
NPI:1598338089
Name:BARRERA, IVONN (RVS, RCS)
Entity Type:Individual
Prefix:
First Name:IVONN
Middle Name:
Last Name:BARRERA
Suffix:
Gender:F
Credentials:RVS, RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7643 CULEBRA VLY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6096
Mailing Address - Country:US
Mailing Address - Phone:210-722-0177
Mailing Address - Fax:
Practice Address - Street 1:6028 SPRING TIME ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2452
Practice Address - Country:US
Practice Address - Phone:325-374-7107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
83927246XC2903X, 246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist