Healthcare Provider Details

I. General information

NPI: 1861064982
Provider Name (Legal Business Name): MONICA IBARRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41111 MISSION BLVD
FREMONT CA
94539-3922
US

IV. Provider business mailing address

370 CAMEO DR
DANVILLE CA
94526-1607
US

V. Phone/Fax

Practice location:
  • Phone: 925-354-1905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: