Healthcare Provider Details

I. General information

NPI: 1245469634
Provider Name (Legal Business Name): JUNTOS PODEMOS II, INC / DAVID IBARBO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 4TH ST NW
ALBUQUERQUE NM
87107-1329
US

IV. Provider business mailing address

2715 4TH ST NW
ALBUQUERQUE NM
87107-1329
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-4533
  • Fax: 505-242-4240
Mailing address:
  • Phone: 505-242-4533
  • Fax: 505-242-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLADAC 3668
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberLADAC 3668
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberLADAC 3668
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3668
License Number StateNM

VIII. Authorized Official

Name: MR. DAVID HUMBERTO IBARBO
Title or Position: DIRECTOR/OWNER
Credential: LADAC
Phone: 505-507-3536