Provider Demographics
NPI:1053110759
Name:IBARRA, EILEEN
Entity type:Individual
Prefix:
First Name:EILEEN
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 1:24528 ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-6542
Mailing Address - Country:US
Mailing Address - Phone:424-558-2990
Mailing Address - Fax:
Practice Address - Street 1:8441 TRASK AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1811
Practice Address - Country:US
Practice Address - Phone:714-372-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool