Basic Information
Provider Information | |||||||||
NPI: | 1326386665 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GARCIA | ||||||||
FirstName: | JOVITA | ||||||||
MiddleName: | IBARRA | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 400 | ||||||||
Address2: |   | ||||||||
City: | RED BLUFF | ||||||||
State: | CA | ||||||||
PostalCode: | 960800400 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5305275631 | ||||||||
FaxNumber: | 5305295844 | ||||||||
Practice Location | |||||||||
Address1: | 1445 VISTA WAY | ||||||||
Address2: |   | ||||||||
City: | RED BLUFF | ||||||||
State: | CA | ||||||||
PostalCode: | 960804510 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5305275631 | ||||||||
FaxNumber: | 5305295844 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/22/2013 | ||||||||
LastUpdateDate: | 01/22/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X |   |   | Y |   | Agencies | Case Management |   |
No ID Information.