Provider Demographics
NPI:1669041513
Name:IBARRA, ROSA MARINA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:MARINA
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 1:2801 MISSOURI AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5062
Mailing Address - Country:US
Mailing Address - Phone:575-915-1338
Mailing Address - Fax:
Practice Address - Street 1:2801 MISSOURI AVE STE 22
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5062
Practice Address - Country:US
Practice Address - Phone:575-915-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy