Provider Demographics
NPI:1013082726
Name:IBARRA, FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:IBARRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4730
Mailing Address - Country:US
Mailing Address - Phone:626-284-1350
Mailing Address - Fax:626-284-2454
Practice Address - Street 1:850 S ATLANTIC BLVD
Practice Address - Street 2:SUITE # 101
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4730
Practice Address - Country:US
Practice Address - Phone:626-284-1350
Practice Address - Fax:626-284-2454
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38493207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0064560Medicaid
CASUR01185FMedicaid
CASUR01185FMedicaid
CAWA38493RMedicare PIN