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NPI Code Detail

MEDICARE: DR. IRUBIEL ALFONSO BARBOSA D.D.S.

MEDICARE: DR. IRUBIEL ALFONSO BARBOSA D.D.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
11223G0001XGeneral Practice Dentistry42804CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1D42804OTHERCADEN-TICAL

General Provider Information

NPI Number : 1710016134
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IRUBIEL ALFONSO BARBOSA D.D.S.
Provider Business Mailing Address
First Line : 4901 YORK BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90042-1609
Country : US
Telephone Number : 323-475-1515
Fax Number : 323-254-6622
Provider Business Practice Location Address
First Line : 4901 YORK BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90042-1609
Country : US
Telephone Number : 323-478-1515
Fax Number : 323-254-6622
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2007
Last Update Date : 07/08/2007

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