Provider Demographics
NPI:1972245397
Name:IBARRA YAMAMOTO, TIANA MIEKO (DO)
Entity type:Individual
Prefix:DR
First Name:TIANA
Middle Name:MIEKO
Last Name:IBARRA YAMAMOTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TIANA
Other - Middle Name:MIEKO
Other - Last Name:NADING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1415 E KINCAID ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4126
Mailing Address - Country:US
Mailing Address - Phone:360-814-2349
Mailing Address - Fax:
Practice Address - Street 1:1415 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4126
Practice Address - Country:US
Practice Address - Phone:360-814-2349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program