Provider Demographics
NPI:1346815321
Name:YBARRA, SIVANAH
Entity Type:Individual
Prefix:
First Name:SIVANAH
Middle Name:
Last Name:YBARRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAVA
Other - Middle Name:
Other - Last Name:YBARRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:318 S LEE ST
Mailing Address - Street 2:
Mailing Address - City:GARRETT
Mailing Address - State:IN
Mailing Address - Zip Code:46738-1575
Mailing Address - Country:US
Mailing Address - Phone:260-357-8090
Mailing Address - Fax:
Practice Address - Street 1:318 S LEE ST
Practice Address - Street 2:
Practice Address - City:GARRETT
Practice Address - State:IN
Practice Address - Zip Code:46738-1575
Practice Address - Country:US
Practice Address - Phone:260-357-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program