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NPI Code Detail

MEDICARE: MIREYA MORENO IBARRA

MEDICARE: MIREYA MORENO IBARRA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1548784689
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIREYA MORENO IBARRA
Provider Business Mailing Address
First Line : 401 E 3RD ST STE 101
Second Line :
City : THE DALLES
State : OR
Zip : 97058-2563
Country : US
Telephone Number : 541-298-2101
Fax Number :
Provider Business Practice Location Address
First Line : 3729 KLINDT DR
Second Line :
City : THE DALLES
State : OR
Zip : 97058-3566
Country : US
Telephone Number : 541-298-2101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2017
Last Update Date : 01/30/2024

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Directions to “ MIREYA MORENO IBARRA ” Practice Location

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