Active NPI
Phillip F Ybarra, C053610518
- Case Manager/Care Coordinator
- Lake Elsinore, CA
National Provider Identifier
1871798371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 31764 Casino Drive-300
Lake Elsinore, CA 92530-7428 - Phone
- (951) 471-4645
- Fax
- (951) 471-4687
- NPI assigned
- Jun 15, 2007
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | C053610518 | CA | |
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
31764 Casino Drive-300
Lake Elsinore, CA 92530-7428
Mailing address
2020 Iowa Ave Ste 101
Riverside, CA 92507-7428
Phone (951) 384-4699
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4386 | Other | CA | SIMON STAFF NUMBER |
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 |
|---|---|---|---|
| C053610518 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715644800000",
"number": "1871798371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2020 IOWA AVE STE 101",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925077428",
"telephone_number": "951-384-4699",
"fax_number": "951-384-4750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31764 CASINO DRIVE-300",
"city": "LAKE ELSINORE",
"state": "CA",
"postal_code": "925307428",
"telephone_number": "951-471-4645",
"fax_number": "951-471-4687"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YBARRA",
"first_name": "PHILLIP",
"middle_name": "F",
"credential": "C053610518",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-15",
"last_updated": "2024-05-14",
"certification_date": "2024-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "C053610518",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SIMON STAFF NUMBER",
"identifier": "4386",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Elsinore, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 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.