Provider Demographics
NPI:1609045103
Name:IBON, INC.
Entity Type:Organization
Organization Name:IBON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OBIAGELI
Authorized Official - Middle Name:B
Authorized Official - Last Name:AGBU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-515-1582
Mailing Address - Street 1:550 E CARSON PLAZA DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3229
Mailing Address - Country:US
Mailing Address - Phone:310-515-1582
Mailing Address - Fax:310-515-1583
Practice Address - Street 1:550 E CARSON PLAZA DR
Practice Address - Street 2:SUITE 107
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3229
Practice Address - Country:US
Practice Address - Phone:310-515-1582
Practice Address - Fax:310-515-1583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48846332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6103300001Medicare NSC