Provider Demographics
NPI:1154107183
Name:BELLOC, MARIANA ESTELLA IBARRA
Entity type:Individual
Prefix:
First Name:MARIANA ESTELLA
Middle Name:IBARRA
Last Name:BELLOC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 E MOHAVE CIR # 90
Mailing Address - Street 2:
Mailing Address - City:ELOY
Mailing Address - State:AZ
Mailing Address - Zip Code:85131-2198
Mailing Address - Country:US
Mailing Address - Phone:520-660-9386
Mailing Address - Fax:
Practice Address - Street 1:632 E MOHAVE CIR # 90
Practice Address - Street 2:
Practice Address - City:ELOY
Practice Address - State:AZ
Practice Address - Zip Code:85131-2198
Practice Address - Country:US
Practice Address - Phone:520-660-9386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBACB490769103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst