Healthcare Provider Details

I. General information

NPI: 1033615828
Provider Name (Legal Business Name): JAVIER G IBARRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21535 HAWTHORNE BLVD STE 102
TORRANCE CA
90503-6626
US

IV. Provider business mailing address

21535 HAWTHORNE BLVD STE 102
TORRANCE CA
90503-6626
US

V. Phone/Fax

Practice location:
  • Phone: 310-817-2177
  • Fax:
Mailing address:
  • Phone: 310-817-2177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT105304
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT124318
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number105304
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: