Individual
MR. SERGIO MIGUEL IBARRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, EMT
Contact information
Practice address
5500 CAMPANILE DRIVE, SAN DIEGO, CA 92182-4313
(619) 594-7652
(619) 594-7654
Mailing address
6766 KELLY ST APT 4, SAN DIEGO, CA 92111-6553
(805) 245-0211
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
001749
NY
2255A2300X
Athletic Trainer
Primary
090602134
CA
2255A2300X
Athletic Trainer
25MT00203400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090602134
NATIONAL ATHLETIC TRAINER'S ASSOCIATION
CA
Enumeration date
12/02/2019
Last updated
12/02/2019
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