Provider Demographics
NPI:1265062517
Name:COBARRUBIA, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:COBARRUBIA
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 1:610 STILLWELL AVE
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-3752
Mailing Address - Country:US
Mailing Address - Phone:503-842-9622
Mailing Address - Fax:
Practice Address - Street 1:TILLAMOOK FAMILY YMCA
Practice Address - Street 2:610 STILLWELL AVE.
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141
Practice Address - Country:US
Practice Address - Phone:503-842-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR174H00000XMedicaid