Healthcare Provider Details

I. General information

NPI: 1316853575
Provider Name (Legal Business Name): ELIZABETH JANINE YBARRA MSN, RN, CSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 UTAH TRL
TWENTYNINE PALMS CA
92277-6917
US

IV. Provider business mailing address

7479 KELLOGG AVE
TWENTYNINE PALMS CA
92277-3879
US

V. Phone/Fax

Practice location:
  • Phone: 760-367-9191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number845588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: