Active NPI
Kasandra Jasmine Ibarra, CTRS
- Addiction (Substance Use Disorder) Counselor
- Los Angeles, CA
National Provider Identifier
1710690748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 18041
- Practice address
- 12021 Wilmington Ave
BLDG. 18 Suite 300
Los Angeles, CA 90059 - Phone
- (424) 454-6041
- NPI assigned
- Jan 4, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | CA | ||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 18041 | CA | Primary |
Addresses
Primary practice location
12021 Wilmington Ave
BLDG. 18 Suite 300
Los Angeles, CA 90059
Mailing address
12021 Wilmington Ave
BLDG. 18 Suite 300
Los Angeles, CA 90059
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18041 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727136000000",
"number": "1710690748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12021 WILMINGTON AVE",
"address_2": "BLDG. 18 SUITE 300",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12021 WILMINGTON AVE",
"address_2": "BLDG. 18 SUITE 300",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90059",
"telephone_number": "424-454-6041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBARRA",
"first_name": "KASANDRA",
"middle_name": "JASMINE",
"credential": "CTRS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-04",
"last_updated": "2024-09-24",
"certification_date": "2024-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "18041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 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.