Provider Demographics
NPI:1417319856
Name:GARIBAY, JACQUELINE (LVN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:GARIBAY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:MEDINA GARIBAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:9854 SAINT GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-5251
Mailing Address - Country:US
Mailing Address - Phone:619-490-9661
Mailing Address - Fax:
Practice Address - Street 1:9854 SAINT GEORGE ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-5251
Practice Address - Country:US
Practice Address - Phone:619-490-9661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site