MEDICARE: KARINA 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	106E00000X	Assistant Behavior Analyst		CA

General Provider Information

NPI Number	:	1316892821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARINA IBANEZ

Provider Business Mailing Address
First Line	:	1412 ELWOOD ST APT C
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91768-2217
Country	:	US
Telephone Number	:	909-786-8470
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 ELWOOD ST APT C
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91768-2217
Country	:	US
Telephone Number	:	909-786-8470
Fax Number	:

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ KARINA IBANEZ ” Practice Location

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