Provider Demographics
NPI:1528588837
Name:IBARRA, ROSALINDA (LISAC)
Entity Type:Individual
Prefix:MRS
First Name:ROSALINDA
Middle Name:
Last Name:IBARRA
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ELOY
Mailing Address - State:AZ
Mailing Address - Zip Code:85131-2506
Mailing Address - Country:US
Mailing Address - Phone:520-466-7765
Mailing Address - Fax:520-466-4475
Practice Address - Street 1:107 EAST 4TH STREET
Practice Address - Street 2:
Practice Address - City:ELOY
Practice Address - State:AZ
Practice Address - Zip Code:85131
Practice Address - Country:US
Practice Address - Phone:520-466-7765
Practice Address - Fax:520-466-4475
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-15068101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)