MEDICARE: IVONN BARRERA RVS, RCS

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	246XC2903X	Vascular Specialist/Technologist Cardiovascular	83927
2	246XS1301X	Sonography Specialist/Technologist Cardiovascular	83927

General Provider Information

NPI Number	:	1598338089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVONN BARRERA RVS, RCS

Provider Business Mailing Address
First Line	:	7643 CULEBRA VLY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-6096
Country	:	US
Telephone Number	:	210-722-0177
Fax Number	:

Provider Business Practice Location Address
First Line	:	6028 SPRING TIME ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2452
Country	:	US
Telephone Number	:	325-374-7107
Fax Number	:

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

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	07/21/2021

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