Healthcare Provider Details

I. General information

NPI: 1568673234
Provider Name (Legal Business Name): IBANEZ INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 SARATOGA BLVD STE 280
CORPUS CHRISTI TX
78414-4120
US

IV. Provider business mailing address

5920 SARATOGA BLVD STE 475
CORPUS CHRISTI TX
78414-4119
US

V. Phone/Fax

Practice location:
  • Phone: 361-985-1221
  • Fax: 361-985-1295
Mailing address:
  • Phone: 361-654-2064
  • Fax: 361-654-2068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELE IBANEZ
Title or Position: GENERAL PARTNER
Credential: M.D.
Phone: 361-654-2064