=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902771025
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUBY IBARRA LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2025
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 204 ANGELINA BLVD
-----------------------------------------------------
City | CHAPARRAL
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88081-7558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-824-8100
-----------------------------------------------------
Fax | 505-443-8330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 204 ANGELINA BLVD
-----------------------------------------------------
City | CHAPARRAL
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88081-7558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-824-8100
-----------------------------------------------------
Fax | 505-443-8330
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SWN-2025-1096
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------