Provider Demographics
NPI:1255508594
Name:IRAEE, ZIBA GHANBARI (MD)
Entity Type:Individual
Prefix:DR
First Name:ZIBA
Middle Name:GHANBARI
Last Name:IRAEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ZIBA
Other - Middle Name:
Other - Last Name:GHANBARI IRAEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:800 SWIFT BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3549
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:
Practice Address - Street 1:9605 SANDIFUR PKWY
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-8028
Practice Address - Country:US
Practice Address - Phone:509-942-3170
Practice Address - Fax:509-942-3203
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60011756208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics