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General NPI Number Information
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NPI Number | 1225757511
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Entity Type | Individual
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Provider Name | FAVIOLA IBARRA M.S, CF-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 4156 24TH ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94114-3615
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Country | US
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Telephone | 415-226-7049
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Fax |
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Provider Business Mailing Address
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Address Line | 20 GREENWOOD LN
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City | REDWOOD CITY
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State | CA
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Zip | 94063-2921
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 17032
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License Number State | CA
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