Provider Demographics
NPI:1295207157
Name:YBARRA, MATTHEW (RCP, RRT-NPS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:YBARRA
Suffix:
Gender:M
Credentials:RCP, RRT-NPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 CAMELOT CT
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6020
Mailing Address - Country:US
Mailing Address - Phone:916-223-5226
Mailing Address - Fax:
Practice Address - Street 1:59 CAMELOT CT
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6020
Practice Address - Country:US
Practice Address - Phone:916-223-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20905227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified