Healthcare Provider Details

I. General information

NPI: 1497671929
Provider Name (Legal Business Name): RAYMOND IBARRA WELLNESS COACH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 BLEAKWOOD AVE
MONTEREY PARK CA
91754-5901
US

IV. Provider business mailing address

2065 BLEAKWOOD AVE
MONTEREY PARK CA
91754-5901
US

V. Phone/Fax

Practice location:
  • Phone: 213-476-0461
  • Fax:
Mailing address:
  • Phone: 213-476-0461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number26-15577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: