Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 8255 | TX |
NPI | 1033137500 |
---|---|
Provider Name | Ms. Karen Louise Ibarguen |
First Address | Shady Shores, TX 76208-5714 |
Second Address | Carrollton, TX 75007-3100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U86656 | (02) | TX |