Active NPI
Juan Ibarra, DDS
- Dentist
- Fresno, CA
National Provider Identifier
1245060136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 110454
- Practice address
- 2610 Tuolumne St
Fresno, CA 93721-1227 - Phone
- (800) 492-4227
- NPI assigned
- Aug 5, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 110454 | CA | Primary |
Addresses
Primary practice location
2610 Tuolumne St
Fresno, CA 93721-1227
Mailing address
20721 S Pendleton St
Riverdale, CA 93656-9238
Phone (559) 284-4151
Other practice location 1
2630 Tuolumne St
Fresno, CA 93721-1227
Phone (800) 492-4227
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241104003912 | CA | Order and Referring Only - Dentist | 3476086042 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110454 | CA | MD | Clinical Social Worker |
Interoperability endpoints
- juan.ibarra.1@17661.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722902400000",
"number": "1245060136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20721 S PENDLETON ST",
"city": "RIVERDALE",
"state": "CA",
"postal_code": "936569238",
"telephone_number": "559-284-4151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2610 TUOLUMNE ST",
"city": "FRESNO",
"state": "CA",
"postal_code": "937211227",
"telephone_number": "800-492-4227"
}
],
"practiceLocations": [
{
"address_1": "2630 Tuolumne St",
"address_purpose": "LOCATION",
"city": "Fresno",
"state": "CA",
"postal_code": "937211227",
"country_code": "US",
"telephone_number": "800-492-4227",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "IBARRA",
"first_name": "JUAN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-05",
"last_updated": "2024-08-06",
"certification_date": "2024-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "110454",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.