MEDICARE: THERESA IBARRA

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1316331945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA IBARRA

Provider Business Mailing Address
First Line	:	2555 E COLORADO BLVD STE 308
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-6649
Country	:	US
Telephone Number	:	626-449-2433
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 E COLORADO BLVD STE 308
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-6649
Country	:	US
Telephone Number	:	626-449-2433
Fax Number	:

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

Provider Enumeration Date	:	03/20/2015
Last Update Date	:	03/20/2015

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Directions to “ THERESA IBARRA ” Practice Location

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