Provider Demographics
NPI:1952592008
Name:IBARRA, JOHN M
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:IBARRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1518
Mailing Address - Country:US
Mailing Address - Phone:509-624-3314
Mailing Address - Fax:509-747-0952
Practice Address - Street 1:124 E PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1518
Practice Address - Country:US
Practice Address - Phone:509-624-3314
Practice Address - Fax:509-747-0952
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program