Individual provider Active NPI

Marian Consuelo Ibarra

  • Dentist
  • Chula Vista, CA
National Provider Identifier
1437592706
Registry record updated Apr 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
63676 Issued in CA
Practice address
480 4TH Ave Ste 314
Chula Vista, CA 91910-4403
Phone
(619) 425-8060
NPI assigned
Apr 16, 2013
Last updated
Apr 21, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 63676 CA Primary

Addresses

Primary practice location

480 4TH Ave Ste 314
Chula Vista, CA 91910-4403

Mailing address

480 4TH Ave Ste 314
Chula Vista, CA 91910-4403
Phone (619) 425-8060

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260214000188 CA Order and Referring Only - DentistPractitioner - Dentist 2466932918

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
63676CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Bonnie M. Badii, D.D.S., Dental Professional Corporation Dentist Past Accepting new patients
Victor Mora D.D.S. Dentist Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776729600000",
    "number": "1437592706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 4TH AVE STE 314",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919104403",
            "telephone_number": "619-425-8060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 4TH AVE STE 314",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919104403",
            "telephone_number": "619-425-8060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBARRA",
        "first_name": "MARIAN",
        "middle_name": "CONSUELO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-16",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "63676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.