Provider Demographics
NPI:1922663178
Name:IBE, DELORIS N (MD/MHA)
Entity Type:Individual
Prefix:DR
First Name:DELORIS
Middle Name:N
Last Name:IBE
Suffix:
Gender:F
Credentials:MD/MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 CAPELLA RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3321
Mailing Address - Country:US
Mailing Address - Phone:281-788-9289
Mailing Address - Fax:
Practice Address - Street 1:4519 CAPELLA RIVIERA DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3321
Practice Address - Country:US
Practice Address - Phone:281-788-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities