Provider Demographics
NPI:1528934957
Name:IBARRA, ELSY
Entity type:Individual
Prefix:
First Name:ELSY
Middle Name:
Last Name:IBARRA
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 1:1933 W 11TH ST STE I
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3562
Mailing Address - Country:US
Mailing Address - Phone:951-682-0088
Mailing Address - Fax:888-909-4209
Practice Address - Street 1:1933 W 11TH ST STE I
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3562
Practice Address - Country:US
Practice Address - Phone:951-682-0088
Practice Address - Fax:888-909-4209
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker