Healthcare Provider Details

I. General information

NPI: 1710770268
Provider Name (Legal Business Name): YULISSA IBARRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 MARKET ST
VENTURA CA
93003-7783
US

IV. Provider business mailing address

825 A ST
FILLMORE CA
93015-1018
US

V. Phone/Fax

Practice location:
  • Phone: 805-212-4072
  • Fax:
Mailing address:
  • Phone: 805-574-0238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: