Healthcare Provider Details

I. General information

NPI: 1265350763
Provider Name (Legal Business Name): ELLAINE IBAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 E 8TH ST
NATIONAL CITY CA
91950-2956
US

IV. Provider business mailing address

1732 MAY AVE
CHULA VISTA CA
91913
US

V. Phone/Fax

Practice location:
  • Phone: 619-874-2053
  • Fax:
Mailing address:
  • Phone: 619-874-2053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95106042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: