Provider Demographics
NPI:1508512088
Name:IBARRA, LETICIA MARLENE (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:MARLENE
Last Name:IBARRA
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7475 CAMINO ARROYO
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7348
Mailing Address - Country:US
Mailing Address - Phone:408-852-2200
Mailing Address - Fax:408-852-2266
Practice Address - Street 1:7475 CAMINO ARROYO
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7348
Practice Address - Country:US
Practice Address - Phone:408-852-2200
Practice Address - Fax:408-852-2266
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-302285163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty