Provider Demographics
NPI:1629896501
Name:IBANEZ, MARGARET MARY
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:IBANEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 NE 121ST AVE APT LL318
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-5587
Mailing Address - Country:US
Mailing Address - Phone:360-773-2765
Mailing Address - Fax:
Practice Address - Street 1:6221 NE FOURTH PLAIN BLVD APT 130
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7210
Practice Address - Country:US
Practice Address - Phone:360-773-2765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist