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NPI Code Detail

MEDICARE: MIGUEL IBARRA

MEDICARE: MIGUEL IBARRA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112179547OTHERCAKAISER

General Provider Information

NPI Number : 1346883840
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIGUEL IBARRA
Provider Business Mailing Address
First Line : 450 STONY POINT RD APT 103
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-5970
Country : US
Telephone Number : 707-703-0857
Fax Number :
Provider Business Practice Location Address
First Line : 438 EDDIE LN
Second Line :
City : SEBASTOPOL
State : CA
Zip : 95472-3425
Country : US
Telephone Number : 707-823-8722
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2019
Last Update Date : 08/28/2024

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Directions to “ MIGUEL IBARRA ” Practice Location

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