1902843410 NPI number — SANDRA K YBARRA F.N.P.

Table of content: SANDRA K YBARRA F.N.P. (NPI 1902843410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902843410 NPI number — SANDRA K YBARRA F.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YBARRA
Provider First Name:
SANDRA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
F.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YBARRA
Provider Other First Name:
SANDRA
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PAC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1902843410
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10049 RUBICON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENTURA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93004-2803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-647-0676
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EHS 800 S VICTORIA
Provider Second Line Business Practice Location Address:
SBCH-ED PUEBO @BATH, SANTA BARBARA, CA ED
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93009-1150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-654-3814
Provider Business Practice Location Address Fax Number:
805-654-5028
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  NP10068 / RN446139 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA22219 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RN446139 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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