Healthcare Provider Details

I. General information

NPI: 1124708276
Provider Name (Legal Business Name): MARIANA ULIBARRI HORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 75 BOX 1198
RUTHERON NM
87551-9725
US

IV. Provider business mailing address

HC 75 BOX 1198
RUTHERON NM
87551-9725
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-5315
  • Fax:
Mailing address:
  • Phone: 505-699-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: