Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 1018443 | TX |
NPI | 1013594258 |
---|---|
Provider Name | Debora E Ybarra |
First Address | Houston, TX 77041-9236 |
Second Address | Jersey Village, TX 77065-5626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2021 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
334123201 | (05) | TX |