Healthcare Provider Details

I. General information

NPI: 1912734476
Provider Name (Legal Business Name): NOVA MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13503 MESA CREST DR
YUCAIPA CA
92399-5820
US

IV. Provider business mailing address

13503 MESA CREST DR
YUCAIPA CA
92399-5820
US

V. Phone/Fax

Practice location:
  • Phone: 909-235-6326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERTO L IBARRA
Title or Position: FOUNDER
Credential: PSYD
Phone: 562-883-3492