Provider Demographics
NPI:1770077760
Name:IBARRA BECERRA, PRISCILA MARINA (MD)
Entity type:Individual
Prefix:DR
First Name:PRISCILA
Middle Name:MARINA
Last Name:IBARRA BECERRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 S GULPH RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:956-292-0781
Mailing Address - Fax:956-380-4012
Practice Address - Street 1:1200 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5516
Practice Address - Country:US
Practice Address - Phone:956-292-0781
Practice Address - Fax:956-380-4012
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS9522207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1O9093OtherPTAN