MEDICARE: CARLOS ADRIAN GARCIA IBARRA BBS ASW99826

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	ASW99826	CA
2	101YM0800X	Mental Health Counselor	ASW99826	CA

General Provider Information

NPI Number	:	1518248871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS ADRIAN GARCIA IBARRA BBS ASW99826

Provider Business Mailing Address
First Line	:	1631 N BROOKS AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-4902
Country	:	US
Telephone Number	:	559-445-5667
Fax Number	:

Provider Business Practice Location Address
First Line	:	1631 N BROOKS AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-4902
Country	:	US
Telephone Number	:	559-446-5667
Fax Number	:

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

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	05/20/2026

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