Provider Demographics
NPI:1114753506
Name:IBARRA NORIEGA, ANA MAGDALENA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:MAGDALENA
Last Name:IBARRA NORIEGA
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 1:901 S HIGHWAY 123 BYP
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-9719
Mailing Address - Country:US
Mailing Address - Phone:830-372-3725
Mailing Address - Fax:
Practice Address - Street 1:901 S HIGHWAY 123 BYP
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-9719
Practice Address - Country:US
Practice Address - Phone:830-372-3725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX409511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry