Provider Demographics
NPI:1356781843
Name:IBARRA, LAUREN NICOLE (DO)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:NICOLE
Last Name:IBARRA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:NICOLE
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4165 E. TOLEDO ST.
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295
Mailing Address - Country:US
Mailing Address - Phone:480-961-2365
Mailing Address - Fax:480-961-2382
Practice Address - Street 1:4530 E. MUIRWOOD DR STE 111
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048
Practice Address - Country:US
Practice Address - Phone:480-962-2365
Practice Address - Fax:480-961-2382
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR22432084N0400X
AZ007128208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology