Healthcare Provider Details

I. General information

NPI: 1679773527
Provider Name (Legal Business Name): MARIA FERNANDA IBARRA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM ROAD
KANSAS CITY MO
64108
US

IV. Provider business mailing address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 816-234-3686
  • Fax: 816-234-3082
Mailing address:
  • Phone: 816-234-3686
  • Fax: 816-234-3082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number2010018430
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: