Healthcare Provider Details

I. General information

NPI: 1730531260
Provider Name (Legal Business Name): MARIA ISABEL IBARDOLAZA AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 07/22/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CONTINENTAL BLVD STE 560
EL SEGUNDO CA
90245-5030
US

IV. Provider business mailing address

300 CONTINENTAL BLVD. SUITE 560
HUNTINGTON BEACH CA
92649-3248
US

V. Phone/Fax

Practice location:
  • Phone: 310-658-3775
  • Fax:
Mailing address:
  • Phone: 310-658-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95003734
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95003734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: