Healthcare Provider Details

I. General information

NPI: 1205629755
Provider Name (Legal Business Name): JOANNA IBANEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 02/22/2026
Certification Date: 02/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 E WALNUT AVE
MONROVIA CA
91016-3431
US

IV. Provider business mailing address

301 EAST ARROW HIGHWAY STE 101 PMB 1023
SAN DIMAS CA
91773
US

V. Phone/Fax

Practice location:
  • Phone: 323-238-6902
  • Fax:
Mailing address:
  • Phone: 626-766-5215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95034630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: