Healthcare Provider Details

I. General information

NPI: 1437292539
Provider Name (Legal Business Name): FRANCISCO IBARRA SANCHEZ CADTP1694
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 E OCEAN AVE
LOMPOC CA
93436-7088
US

IV. Provider business mailing address

124 CARMEN LN STE A
SANTA MARIA CA
93458-7768
US

V. Phone/Fax

Practice location:
  • Phone: 180-563-1671
  • Fax:
Mailing address:
  • Phone: 805-348-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADTP1694
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1316192149
Identifier TypeOTHER
Identifier State
Identifier IssuerTELECARE SANTA MARIA ACT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: