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Individual

JUAN CARLOS IBARRA MORENO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
SA-C

Contact information

Practice address
6150 DIAMOND CENTRE CT UNIT 1200, FORT MYERS, FL 33912-7135
(239) 344-9786
(239) 344-9215
Mailing address
6150 DIAMOND CENTRE CT # 1300, FORT MYERS, FL 33912-4367
(239) 344-9786

Taxonomy

Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
13-514
FL

Other

Enumeration date
11/15/2016
Last updated
04/10/2020
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