Provider Demographics
NPI:1033369657
Name:YBARRA, ELAINE (AN P)
Entity Type:Individual
Prefix:PROF
First Name:ELAINE
Middle Name:
Last Name:YBARRA
Suffix:
Gender:F
Credentials:AN P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17215 STUDEBAKER RD STE 320
Mailing Address - Street 2:SUITE #300
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2522
Mailing Address - Country:US
Mailing Address - Phone:562-860-8771
Mailing Address - Fax:562-207-6581
Practice Address - Street 1:17215 STUDEBAKER RD STE 320
Practice Address - Street 2:SUITE #300
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2522
Practice Address - Country:US
Practice Address - Phone:562-860-8771
Practice Address - Fax:562-207-6581
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA446138363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10186OtherSTATE