MEDICARE: CARINA IBARRA A.A.S

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	171R00000X	Interpreter

General Provider Information

NPI Number	:	1306076773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARINA IBARRA A.A.S

Provider Business Mailing Address
First Line	:	2717 N SAINT LOUIS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1228
Country	:	US
Telephone Number	:	773-905-4730
Fax Number	:	773-685-3669

Provider Business Practice Location Address
First Line	:	2717 N SAINT LOUIS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1228
Country	:	US
Telephone Number	:	773-905-4730
Fax Number	:	773-685-3669

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

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	01/12/2012

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