Provider Demographics
NPI:1003447434
Name:UBILLA, IGNACIO A
Entity Type:Individual
Prefix:
First Name:IGNACIO
Middle Name:A
Last Name:UBILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 MIAMI ST APT A
Mailing Address - Street 2:
Mailing Address - City:NORTH MANCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46962-1281
Mailing Address - Country:US
Mailing Address - Phone:317-625-0723
Mailing Address - Fax:
Practice Address - Street 1:606 MIAMI ST APT A
Practice Address - Street 2:
Practice Address - City:NORTH MANCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46962-1281
Practice Address - Country:US
Practice Address - Phone:317-625-0723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer