Healthcare Provider Details

I. General information

NPI: 1053719385
Provider Name (Legal Business Name): CRISTINA IBARRA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19314 JESSE LN STE 100
RIVERSIDE CA
92508-5070
US

IV. Provider business mailing address

12980 FREDERICK ST STE J
MORENO VALLEY CA
92553-5263
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-3045
  • Fax: 951-776-4513
Mailing address:
  • Phone: 951-924-9300
  • Fax: 951-485-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95001772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: