MEDICARE: MS. LOURDES M IBANEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1174846885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LOURDES M IBANEZ

Provider Business Mailing Address
First Line	:	5921 BELLAIRE BLVD
Second Line	:	STE B
City	:	HOUSTON
State	:	TX
Zip	:	77081-5524
Country	:	US
Telephone Number	:	713-432-7212
Fax Number	:	713-432-1503

Provider Business Practice Location Address
First Line	:	5921 BELLAIRE BLVD
Second Line	:	STE B
City	:	HOUSTON
State	:	TX
Zip	:	77081-5524
Country	:	US
Telephone Number	:	713-432-7212
Fax Number	:	713-432-1503

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	03/09/2010

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