Individual
MR. IBARRA GAMBOTA DIANGKINAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
850 E LATHAM AVE STE 201, HEMET, CA 92543-4391
(951) 925-6657
Mailing address
850 E LATHAM AVE STE 201, HEMET, CA 92543-4391
(951) 925-6657
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
95004040
CA
Other
Enumeration date
04/11/2016
Last updated
04/11/2016
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