Provider Demographics
NPI:1821779679
Name:BAKPO, IBIENEBARI JESSICA
Entity Type:Individual
Prefix:
First Name:IBIENEBARI
Middle Name:JESSICA
Last Name:BAKPO
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 1:326 E 148TH ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5770
Mailing Address - Country:US
Mailing Address - Phone:682-392-0989
Mailing Address - Fax:
Practice Address - Street 1:234 E 149TH ST DEPT OF
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program