Provider Demographics
NPI:1700073863
Name:IBANEZ, CLARIZA AMPARO (RPT)
Entity type:Individual
Prefix:
First Name:CLARIZA
Middle Name:AMPARO
Last Name:IBANEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9652 BELCHER ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-4811
Mailing Address - Country:US
Mailing Address - Phone:562-803-1949
Mailing Address - Fax:562-803-1949
Practice Address - Street 1:9652 BELCHER ST
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-4811
Practice Address - Country:US
Practice Address - Phone:562-803-1949
Practice Address - Fax:562-803-1949
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT29742AOtherMEDICARE PPIN
CAWPT29742AOtherMEDICARE PPIN