Healthcare Provider Details

I. General information

NPI: 1033682174
Provider Name (Legal Business Name): CLAUDIA CARINA IBAL VERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 N MARKS AVE
FRESNO CA
93711-0268
US

IV. Provider business mailing address

14160 W B ST
KERMAN CA
93630-1986
US

V. Phone/Fax

Practice location:
  • Phone: 559-283-9763
  • Fax:
Mailing address:
  • Phone: 559-696-2765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number85887
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: