Healthcare Provider Details

I. General information

NPI: 1043767353
Provider Name (Legal Business Name): GENESIS IBARRA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SAN BERNARDINO RD STE 1100
UPLAND CA
91786-4952
US

IV. Provider business mailing address

1100 SAN BERNARDINO RD STE 1100
UPLAND CA
91786-4952
US

V. Phone/Fax

Practice location:
  • Phone: 626-218-7536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number89977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: