Provider Demographics
NPI:1881478808
Name:IBARRA PEREZ, MARITZA YANELLA
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:YANELLA
Last Name:IBARRA PEREZ
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 1:2778 HARMONIA HAMMOCK RD
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:FL
Mailing Address - Zip Code:34773-6132
Mailing Address - Country:US
Mailing Address - Phone:402-969-0638
Mailing Address - Fax:
Practice Address - Street 1:3201 BUDINGER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-7203
Practice Address - Country:US
Practice Address - Phone:407-498-4079
Practice Address - Fax:407-624-5681
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-291621106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician