Provider Demographics
NPI:1053719385
Name:IBARRA, CRISTINA (NP)
Entity type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:
Last Name:IBARRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12980 FREDERICK ST STE J
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5263
Mailing Address - Country:US
Mailing Address - Phone:951-924-9300
Mailing Address - Fax:951-485-0204
Practice Address - Street 1:19314 JESSE LN STE 100
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5070
Practice Address - Country:US
Practice Address - Phone:951-782-3045
Practice Address - Fax:951-776-4513
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95001772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily