MEDICARE: JUSTINE IBANEZ IPAC PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1306417647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINE IBANEZ IPAC PA-C

Provider Business Mailing Address
First Line	:	2701 N TENAYA WAY STE 290
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1406
Country	:	US
Telephone Number	:	702-420-2163
Fax Number	:	702-420-2930

Provider Business Practice Location Address
First Line	:	2701 N TENAYA WAY STE 290
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1406
Country	:	US
Telephone Number	:	702-420-2163
Fax Number	:	702-420-2930

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	04/23/2024

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Directions to “ JUSTINE IBANEZ IPAC PA-C” Practice Location

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