Basic Information
| Provider Information | |||||||||
| NPI: | 1255795647 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IBARRA | ||||||||
| FirstName: | BIANCA | ||||||||
| MiddleName: | GUADALUPE | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2102 TREASURE HILLS BLVD | ||||||||
| Address2: | #3.144.05 | ||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785508736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9562961437 | ||||||||
| FaxNumber: | 9562966842 | ||||||||
| Practice Location | |||||||||
| Address1: | 2821 MICHAELANGELO DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785391405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563623590 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2016 | ||||||||
| LastUpdateDate: | 08/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | BP10055823 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.