MEDICARE: JAMES M IBARRA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	373H00000X	Day Training/Habilitation Specialist	CA
2	101YM0800X	Mental Health Counselor
3	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1073993853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES M IBARRA

Provider Business Mailing Address
First Line	:	6244 EL CAJON BLVD
Second Line	:	SAN DIEGO
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3918
Country	:	US
Telephone Number	:	619-640-3266
Fax Number	:	619-640-3269

Provider Business Practice Location Address
First Line	:	6244 EL CAJON BLVD
Second Line	:	SAN DIEGO
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3918
Country	:	US
Telephone Number	:	619-640-3266
Fax Number	:	619-640-3269

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	03/18/2026

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Directions to “ JAMES M IBARRA ” Practice Location

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