Healthcare Provider Details

I. General information

NPI: 1144419680
Provider Name (Legal Business Name): MR. ERIK JAMES YBARRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 LUNDY AVE STE 223
SAN JOSE CA
95131-1888
US

IV. Provider business mailing address

755 E CAPITOL AVE APT H112
MILPITAS CA
95035-6889
US

V. Phone/Fax

Practice location:
  • Phone: 408-284-9000
  • Fax: 408-254-9960
Mailing address:
  • Phone: 408-946-4167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: