Provider Demographics
NPI:1417544818
Name:YBARBO, MARIO NOE
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:NOE
Last Name:YBARBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 ELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1937
Mailing Address - Country:US
Mailing Address - Phone:937-245-9151
Mailing Address - Fax:
Practice Address - Street 1:114 ELLINGTON RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:OH
Practice Address - Zip Code:45431-1937
Practice Address - Country:US
Practice Address - Phone:937-245-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist