Provider Demographics
NPI:1245557503
Name:GARIBAY, SANDRA (COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:GARIBAY
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:PIMENTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2085 RUSTIN AVE # 3
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2498
Mailing Address - Country:US
Mailing Address - Phone:951-737-2962
Mailing Address - Fax:
Practice Address - Street 1:2085 RUSTIN AVE # 3
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2498
Practice Address - Country:US
Practice Address - Phone:951-955-2105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC10951214101YA0400X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1033645239OtherRIVERSIDE UNIVERSITY HEALTH SYSTEM
CAC10951214OtherCALIFORNIA CONSORTIUM OF ADDICTION PROGRAMS AND PROFESSIONALS