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General NPI Number Information
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NPI Number | 1053719385
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Entity Type | Individual
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Provider Name | CRISTINA IBARRA NP
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Gender | Female
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Dates
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Enumeration Date | 12/19/2014
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 19314 JESSE LN STE 100
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City | RIVERSIDE
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State | CA
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Zip | 92508-5070
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Country | US
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Telephone | 951-782-3045
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Fax | 951-776-4513
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Provider Business Mailing Address
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Address Line | 12980 FREDERICK ST STE J
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City | MORENO VALLEY
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State | CA
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Zip | 92553-5263
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Country | US
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Telephone | 951-924-9300
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Fax | 951-485-0204
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95001772
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License Number State | CA
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