Provider Demographics
NPI:1477432672
Name:IBANEZ, ALEXANDRA GUADALUPE
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:GUADALUPE
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 1:388 COUNTY ROAD 1475
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-7305
Mailing Address - Country:US
Mailing Address - Phone:903-305-2299
Mailing Address - Fax:
Practice Address - Street 1:1910 E SOUTHEAST LOOP 323 # 382
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8337
Practice Address - Country:US
Practice Address - Phone:903-305-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other