Healthcare Provider Details

I. General information

NPI: 1053912287
Provider Name (Legal Business Name): CORAZON ILARINA IBARRA MD HMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 RIDGEVIEW DRIVE SUITE 210 1495 RIDGEVIEW DRIVE SUITE 210
RENO NV
89519
US

IV. Provider business mailing address

1495 RIDGEVIEW DRIVE SUITE 210
RENO NV
89519
US

V. Phone/Fax

Practice location:
  • Phone: 775-827-6696
  • Fax: 775-827-8227
Mailing address:
  • Phone: 775-827-6696
  • Fax: 775-827-8227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number8901
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: