Provider Demographics
NPI:1902315252
Name:IBARRA, MARIA LILIANA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LILIANA
Last Name:IBARRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LILIANA
Other - Middle Name:
Other - Last Name:IBARRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LILIANA IBARRA
Mailing Address - Street 1:PO BOX 1534
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-0619
Mailing Address - Country:US
Mailing Address - Phone:360-391-4393
Mailing Address - Fax:
Practice Address - Street 1:100 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1810
Practice Address - Country:US
Practice Address - Phone:361-391-4393
Practice Address - Fax:360-422-5299
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC53320171R00000X
WA0363797171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter