MEDICARE: LAURA IBARRA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1689442238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA IBARRA

Provider Business Mailing Address
First Line	:	2323 N CENTRAL EXPY
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-2712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 N MACARTHUR BLVD # 122-286
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-6419
Country	:	US
Telephone Number	:	817-308-8477
Fax Number	:

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

Provider Enumeration Date	:	12/13/2023
Last Update Date	:	12/11/2025

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Directions to “ LAURA IBARRA ” Practice Location

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