Healthcare Provider Details

I. General information

NPI: 1356781843
Provider Name (Legal Business Name): LAUREN NICOLE IBARRA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN NICOLE BOWEN D.O.

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 E MUIRWOOD DR STE 114
PHOENIX AZ
85048-7693
US

IV. Provider business mailing address

4505 E CHANDLER BLVD STE 200
PHOENIX AZ
85048-7688
US

V. Phone/Fax

Practice location:
  • Phone: 480-962-2365
  • Fax: 480-961-2382
Mailing address:
  • Phone: 480-961-2365
  • Fax: 480-961-2382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number007128
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: