Individual
JAIME IBARRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8210 LANKFORD HWY, OAK HALL, VA 23416-2114
(757) 824-3360
Mailing address
8210 LANKFORD HWY, OAK HALL, VA 23416-2114
(757) 824-3360
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
PPS0600700
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0813000877
—
VA
Enumeration date
11/28/2017
Last updated
11/28/2017
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