Healthcare Provider Details

I. General information

NPI: 1912516683
Provider Name (Legal Business Name): MARGARITA IBARRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54TH CHURCH HILL RD
SANTA FE NM
87508
US

IV. Provider business mailing address

3201 ZAFARANO DR STE C
SANTA FE NM
87507-2672
US

V. Phone/Fax

Practice location:
  • Phone: 505-795-6596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN-62072
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: