Provider Demographics
NPI:1205311537
Name:IBARRA, VERONICA YUNUEN (LICENSED)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:YUNUEN
Last Name:IBARRA
Suffix:
Gender:F
Credentials:LICENSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41880 KALMIA ST
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8831
Mailing Address - Country:US
Mailing Address - Phone:714-922-0539
Mailing Address - Fax:
Practice Address - Street 1:41880 KALMIA ST
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8831
Practice Address - Country:US
Practice Address - Phone:714-922-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109135106H00000X
CA131939106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205311537Medicaid