Basic Information
| Provider Information | |||||||||
| NPI: | 1225757511 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IBARRA | ||||||||
| FirstName: | FAVIOLA | ||||||||
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| Credential: | M.S, CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 GREENWOOD LN | ||||||||
| Address2: | |||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940632921 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4156 24TH ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941143615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152267049 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2022 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 17032 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.