Healthcare Provider Details

I. General information

NPI: 1023899069
Provider Name (Legal Business Name): ALEJANDRA GUZMAN-IBARRA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 MAGNOLIA AVE STE 2A
CORONA CA
92879-3122
US

IV. Provider business mailing address

4071 PENROD DR
RIVERSIDE CA
92505-3436
US

V. Phone/Fax

Practice location:
  • Phone: 951-736-8144
  • Fax:
Mailing address:
  • Phone: 310-997-6538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: