MEDICARE: MR. SERGIO MIGUEL IBARRA ATC, EMT

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	2255A2300X	Athletic Trainer	001749	NY
2	2255A2300X	Athletic Trainer	25MT00203400	NJ
3	2255A2300X	Athletic Trainer	090602134	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	090602134	OTHER	CA	NATIONAL ATHLETIC TRAINER'S ASSOCIATION

General Provider Information

NPI Number	:	1902443518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SERGIO MIGUEL IBARRA ATC, EMT

Provider Business Mailing Address
First Line	:	6766 KELLY ST APT 4
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-6553
Country	:	US
Telephone Number	:	805-245-0211
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 CAMPANILE DRIVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92182-4313
Country	:	US
Telephone Number	:	619-594-7652
Fax Number	:	619-594-7654

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

Provider Enumeration Date	:	12/02/2019
Last Update Date	:	12/02/2019

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1033184064 — CAROLYN RAE PETERS MA, ATC, CSCS
Practice Location Address:

5505 CAMPANILE DR. , AAC 1402
SAN DIEGO, CA
92182-4313

Practice Phone: 619-594-7660
Practice Fax: 619-594-7654

1972531994 — MR. DONALD FREDRICK KESSLER ATC
Practice Location Address:

5500 CAMPANILLE DR
SAN DIEGO, CA
92182-4313

Practice Phone: 619-594-7650
Practice Fax:

1740214709 — TOGETHER WE GROW
Practice Location Address:

5055 VIEWRIDGE AVE
SAN DIEGO, CA
92123-4313

Practice Phone: 858-751-0209
Practice Fax: 858-751-0204

1619637220 — JULIAN HALTON PHC L2, PN1
Practice Location Address:

4451 HAINES ST APT 2
SAN DIEGO, CA
92109-4313

Practice Phone: 857-320-1578
Practice Fax:

1750155719 — ALANA JEAN OLSON RDN
Practice Location Address:

4451 HAINES ST APT 12
SAN DIEGO, CA
92109-4313

Practice Phone: 858-442-7830
Practice Fax:

Directions to “ MR. SERGIO MIGUEL IBARRA ATC, EMT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.