Provider Demographics
NPI:1154667939
Name:YBARRA, ELAINE ELIZABETH (LPT)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:ELIZABETH
Last Name:YBARRA
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935B SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4523
Mailing Address - Country:US
Mailing Address - Phone:530-621-6213
Mailing Address - Fax:
Practice Address - Street 1:935B SPRING ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4523
Practice Address - Country:US
Practice Address - Phone:530-621-6213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-23
Last Update Date:2012-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35809167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician