Provider Demographics
NPI:1043017445
Name:IBARRA, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:IBARRA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3401
Mailing Address - Street 2:
Mailing Address - City:FABENS
Mailing Address - State:TX
Mailing Address - Zip Code:79838-3401
Mailing Address - Country:US
Mailing Address - Phone:720-612-9406
Mailing Address - Fax:
Practice Address - Street 1:426 SE RIVER ST
Practice Address - Street 2:
Practice Address - City:FABENS
Practice Address - State:TX
Practice Address - Zip Code:79838
Practice Address - Country:US
Practice Address - Phone:720-612-9406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter