Healthcare Provider Details

I. General information

NPI: 1821400763
Provider Name (Legal Business Name): LEE IBARRA D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N SAN JACINTO ST STE P
HEMET CA
92543-3154
US

IV. Provider business mailing address

540 N SAN JACINTO ST STE P
HEMET CA
92543-3154
US

V. Phone/Fax

Practice location:
  • Phone: 951-929-4000
  • Fax:
Mailing address:
  • Phone: 951-929-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number65106
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: