Provider Demographics
NPI:1760977433
Name:IBARRA, MARTIN JR (RN)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:IBARRA
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 NESSUH AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-4814
Mailing Address - Country:US
Mailing Address - Phone:956-630-1116
Mailing Address - Fax:
Practice Address - Street 1:1914 SUMMER BREEZE RD APT A
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3191
Practice Address - Country:US
Practice Address - Phone:956-451-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX853382163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics