Provider Demographics
NPI:1376351932
Name:MIGUEL IBARRA
Entity type:Organization
Organization Name:MIGUEL IBARRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-349-6409
Mailing Address - Street 1:237 ROCKWOOD AVE. STE 120 PMB89
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231
Mailing Address - Country:US
Mailing Address - Phone:619-349-6409
Mailing Address - Fax:619-354-2449
Practice Address - Street 1:AV. FRANCISCO I MADERO 1192
Practice Address - Street 2:SEGUNDA SECCION
Practice Address - City:MEXICALI
Practice Address - State:BC
Practice Address - Zip Code:21100
Practice Address - Country:MX
Practice Address - Phone:619-349-6409
Practice Address - Fax:619-354-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty