Individual
MARIO ANTONIO IBARRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
113 LIELMANIS AVE, HURLBURT FIELD, FL 32544-5613
(228) 233-7997
Mailing address
113 LIELMANIS AVE, HURLBURT FIELD, FL 32544-5613
(228) 233-7997
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
05/24/2011
Last updated
10/26/2011
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