Provider Demographics
NPI:1659933000
Name:IBARRA, NALLELY (NMD)
Entity Type:Individual
Prefix:
First Name:NALLELY
Middle Name:
Last Name:IBARRA
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 N MILLER RD STE 5A
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6930
Mailing Address - Country:US
Mailing Address - Phone:480-630-9093
Mailing Address - Fax:
Practice Address - Street 1:3226 N MILLER RD STE 5A
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6930
Practice Address - Country:US
Practice Address - Phone:480-630-9093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-06
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19-1794175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath