Provider Demographics
NPI:1326639758
Name:YBARRA, PRISCILLA
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:YBARRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:LEANNA
Other - Last Name:GARCIA YBARRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1095 WEST BUSINESS 77
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-4846
Mailing Address - Country:US
Mailing Address - Phone:956-399-5046
Mailing Address - Fax:
Practice Address - Street 1:1095 W. BUSINESS 77
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-4846
Practice Address - Country:US
Practice Address - Phone:956-399-5046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248272183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician