Provider Demographics
NPI:1710016134
Name:BARBOSA, IRUBIEL ALFONSO (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRUBIEL
Middle Name:ALFONSO
Last Name:BARBOSA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 YORK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-1609
Mailing Address - Country:US
Mailing Address - Phone:323-475-1515
Mailing Address - Fax:323-254-6622
Practice Address - Street 1:4901 YORK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-1609
Practice Address - Country:US
Practice Address - Phone:323-478-1515
Practice Address - Fax:323-254-6622
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD42804OtherDEN-TICAL