Healthcare Provider Details

I. General information

NPI: 1497592620
Provider Name (Legal Business Name): HUGO DANIEL IBARRA PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23388 MULHOLLAND DR
WOODLAND HILLS CA
91364-2733
US

IV. Provider business mailing address

7947 ETIWANDA AVE
RESEDA CA
91335-2007
US

V. Phone/Fax

Practice location:
  • Phone: 818-876-1888
  • Fax: 818-876-1599
Mailing address:
  • Phone: 818-401-3225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: