Healthcare Provider Details

I. General information

NPI: 1033770615
Provider Name (Legal Business Name): FRANCISCO J. IBARRA V.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MISION DE SAN DIEGO #2993-304 ZONA RIO
TIJUANA B.C.
22010
MX

IV. Provider business mailing address

1428 SILVER HAWK WAY
CHULA VISTA CA
91915
US

V. Phone/Fax

Practice location:
  • Phone: 619-488-2195
  • Fax: 858-430-3143
Mailing address:
  • Phone: 619-488-2195
  • Fax: 858-430-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANCISCO J. IBARRA
Title or Position: OWNER
Credential: DDS
Phone: 619-488-2195