Individual
IDELIA LABRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
421 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 234-7952
Mailing address
421 MEMORIAL DR, POCATELLO, ID 83201-4008
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000
—
ID
Enumeration date
03/04/2016
Last updated
03/04/2016
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