Healthcare Provider Details

I. General information

NPI: 1871539932
Provider Name (Legal Business Name): EDUARDO IBARRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CALLE JULIO CINTRON SUITE 224
AIBONITO PR
00705-3311
US

IV. Provider business mailing address

PO BOX 1869
AIBONITO PR
00705-1869
US

V. Phone/Fax

Practice location:
  • Phone: 787-735-8900
  • Fax: 787-735-3040
Mailing address:
  • Phone: 787-735-8900
  • Fax: 787-735-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number7701
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: