Healthcare Provider Details

I. General information

NPI: 1730995176
Provider Name (Legal Business Name): DANIELA RAMIREZ-IBARRA ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 W MAIN ST
MERCED CA
95340-4718
US

IV. Provider business mailing address

121 GALLO CT
LOS BANOS CA
93635-8304
US

V. Phone/Fax

Practice location:
  • Phone: 209-205-1058
  • Fax: 209-205-1062
Mailing address:
  • Phone: 831-706-7583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number126262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: