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General NPI Number Information
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NPI Number | 1720275886
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Entity Type | Organization
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Legal Business Name | IBANEZ SERVICES INCORPORATED
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 10/02/2007
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Provider Practice Location Address
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Address Line | 9652 BELCHER ST
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City | DOWNEY
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State | CA
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Zip | 90242-4811
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Country | US
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Telephone | 562-803-1949
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Fax | 562-803-1949
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Provider Business Mailing Address
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Address Line | 9652 BELCHER ST
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City | DOWNEY
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State | CA
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Zip | 90242-4811
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Country | US
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Telephone | 562-803-1949
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Fax | 562-803-1949
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Authorized Official
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Title or Position | PRESIDENT
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Name | CLARIZA AMPARO IBANEZ
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Credential | RPT
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Telephone | 562-278-6191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT29742
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License Number State | CA
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