Provider Demographics
NPI:1881853505
Name:IRIBE, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:IRIBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11629 IDALENE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3641
Mailing Address - Country:US
Mailing Address - Phone:562-644-2633
Mailing Address - Fax:
Practice Address - Street 1:9829 CARMENITA RD
Practice Address - Street 2:SUIT H
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-3229
Practice Address - Country:US
Practice Address - Phone:562-907-7429
Practice Address - Fax:562-696-8640
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62038225400000X
101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health