Provider Demographics
NPI:1972684165
Name:YBALLE, LIZA SEDILLO (MD)
Entity Type:Individual
Prefix:DR
First Name:LIZA
Middle Name:SEDILLO
Last Name:YBALLE
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1601 E FOURTH PLAIN BLVD
Mailing Address - Street 2:BUILDING D-7
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3753
Mailing Address - Country:US
Mailing Address - Phone:360-696-4061
Mailing Address - Fax:360-905-1733
Practice Address - Street 1:1601 E FOURTH PLAIN BLVD
Practice Address - Street 2:BUILDING D-7
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3753
Practice Address - Country:US
Practice Address - Phone:360-696-4061
Practice Address - Fax:360-905-1733
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G69121Medicare UPIN