Most Relevant Information
Provider Data
| NPI Number: | 1003594029 |
| Provider Name: | MADISON ANNELISE IBARRA |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/10/2023 |
| Last Updated: | 12/23/2023 |
Provider Practice Location
1212 N CALIFORNIA ST
STOCKTON
CA
952021552
Practice Location Phone/Fax
| Phone: | 2094680103 |
| Fax: |
Provider Mailing Location
1212 N CALIFORNIA ST
STOCKTON
CA
952021552
Provider Mailing Phone/Fax
| Phone: | 2094680103 |
| Fax: |