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General NPI Number Information
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NPI Number | 1518694306
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Entity Type | Individual
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Provider Name | LUPE S IBARRA PHARMACY TECHNICIAN
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Gender | Female
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 630 E 1ST ST
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City | TUSTIN
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State | CA
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Zip | 92780-3418
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Country | US
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Telephone | 714-544-7274
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Fax | 714-544-3517
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Provider Business Mailing Address
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Address Line | 2525 W ELDER AVE
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City | SANTA ANA
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State | CA
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Zip | 92704-3111
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Country | US
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Telephone | 714-697-8288
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Fax |
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 32590
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License Number State | CA
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