Healthcare Provider Details

I. General information

NPI: 1255508594
Provider Name (Legal Business Name): ZIBA GHANBARI IRAEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZIBA GHANBARI IRAEE M.D.

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 01/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9605 SANDIFUR PKWY
PASCO WA
99301-8028
US

IV. Provider business mailing address

800 SWIFT BLVD SUITE 300
RICHLAND WA
99352-3549
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-3170
  • Fax: 509-942-3203
Mailing address:
  • Phone: 509-942-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60011756
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: