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1003594029
MADISON ANNELISE IBARRA
STOCKTON, CA
NPI
1003594029
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
172V00000X Community Health Worker
Additional Taxonomies
106S00000X Behavior Technician
Enumeration Date
2023-07-10
Last Update Date
2023-12-23
Business Address
MADISON ANNELISE IBARRA
1212 N CALIFORNIA ST
STOCKTON, CA 95202-1552
Phone number: 209-468-0103
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Mailing Address
MADISON ANNELISE IBARRA
1212 N CALIFORNIA ST
STOCKTON, CA 95202-1552
Phone number: 209-468-0103
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