Healthcare Provider Details

I. General information

NPI: 1619027927
Provider Name (Legal Business Name): MARIZABEL ULIBARRI LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 CERRILLOS RD.
SANTA FE NM
87501
US

IV. Provider business mailing address

10 CALLE LISA
SANTA FE NM
87507-4268
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-0855
  • Fax:
Mailing address:
  • Phone: 505-438-0010
  • Fax: 505-438-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: