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General NPI Number Information
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NPI Number | 1609325364
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Entity Type | Individual
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Provider Name | MARISELA IBARRA
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Gender | Female
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 108 W VICTORIA ST
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City | GARDENA
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State | CA
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Zip | 90248-3523
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Country | US
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Telephone | 310-715-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 8426 BOYNE ST
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City | DOWNEY
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State | CA
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Zip | 90242-2504
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Country | US
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Telephone | 562-469-9564
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW111579
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License Number State | CA
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