Healthcare Provider Details

I. General information

NPI: 1073993853
Provider Name (Legal Business Name): JAMES M IBARRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMES M IBARRA

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6244 EL CAJON BLVD SAN DIEGO
SAN DIEGO CA
92115-3918
US

IV. Provider business mailing address

6244 EL CAJON BLVD SAN DIEGO
SAN DIEGO CA
92115-3918
US

V. Phone/Fax

Practice location:
  • Phone: 619-640-3266
  • Fax: 619-640-3269
Mailing address:
  • Phone: 619-640-3266
  • Fax: 619-640-3269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: