Provider Demographics
NPI:1336708429
Name:IBARRA, WHITNEY L
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:L
Last Name:IBARRA
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 1:108 ALICE LN
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-1447
Mailing Address - Country:US
Mailing Address - Phone:510-517-4552
Mailing Address - Fax:
Practice Address - Street 1:108 ALICE LN
Practice Address - Street 2:
Practice Address - City:EL SOBRANTE
Practice Address - State:CA
Practice Address - Zip Code:94803-1447
Practice Address - Country:US
Practice Address - Phone:510-517-4552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician