Provider Demographics
NPI:1326385345
Name:GARIBAY-DA ROSA, DORA
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:GARIBAY-DA ROSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DORA
Other - Middle Name:
Other - Last Name:GRAIBAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:650 S BASCOM AVE
Mailing Address - Street 2:STE C
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2601
Mailing Address - Country:US
Mailing Address - Phone:408-283-8555
Mailing Address - Fax:408-279-4825
Practice Address - Street 1:650 S BASCOM AVE
Practice Address - Street 2:STE C
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2601
Practice Address - Country:US
Practice Address - Phone:408-283-8555
Practice Address - Fax:408-279-4825
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)