Provider Demographics
NPI:1194414953
Name:IBARRA, CARMEN ISABEL
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:ISABEL
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 1:85173 AVENIDA YUCATECO
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-3170
Mailing Address - Country:US
Mailing Address - Phone:760-238-3535
Mailing Address - Fax:
Practice Address - Street 1:85173 AVENIDA YUCATECO
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-3170
Practice Address - Country:US
Practice Address - Phone:760-238-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician