Active NPI
Miguel Ibarra
- Student in an Organized Health Care Education/Training Program
- Sebastopol, CA
National Provider Identifier
1346883840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 438 Eddie LN
Sebastopol, CA 95472-3425 - Phone
- (707) 823-8722
- NPI assigned
- Oct 28, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary | ||
| Mental Health Counselor | 101YM0800X |
Addresses
Primary practice location
438 Eddie LN
Sebastopol, CA 95472-3425
Mailing address
450 Stony Point Rd Apt 103
Santa Rosa, CA 95401-5970
Phone (707) 703-0857
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12179547 | Other | CA | KAISER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724803200000",
"number": "1346883840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 STONY POINT RD APT 103",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954015970",
"telephone_number": "707-703-0857"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "438 EDDIE LN",
"city": "SEBASTOPOL",
"state": "CA",
"postal_code": "954723425",
"telephone_number": "707-823-8722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBARRA",
"first_name": "MIGUEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-28",
"last_updated": "2024-08-28",
"certification_date": "2024-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER",
"identifier": "12179547",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sebastopol, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.