MEDICARE: OMAR 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
1	363A00000X	Physician Assistant	PA64594	CA

General Provider Information

NPI Number	:	1548025570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAR IBARRA

Provider Business Mailing Address
First Line	:	40910 FREMONT BLVD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-4375
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40910 FREMONT BLVD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-4375
Country	:	US
Telephone Number	:	510-770-8040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2024
Last Update Date	:	01/22/2026

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Directions to “ OMAR IBARRA ” Practice Location

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