Provider Demographics
NPI:1972617785
Name:YBARRA, GABRIEL J (PHD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:J
Last Name:YBARRA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4110 SOUTHPOINT BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0925
Mailing Address - Country:US
Mailing Address - Phone:904-652-2420
Mailing Address - Fax:904-281-9221
Practice Address - Street 1:4110 SOUTHPOINT BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0925
Practice Address - Country:US
Practice Address - Phone:904-652-2420
Practice Address - Fax:904-281-9221
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7065103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU7227Medicare ID - Type UnspecifiedPSYCHOLOGIST