Provider Demographics
NPI:1467136200
Name:GARIBAY, JUAN ANDRES
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ANDRES
Last Name:GARIBAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 ALICE ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-4702
Mailing Address - Country:US
Mailing Address - Phone:209-808-1064
Mailing Address - Fax:
Practice Address - Street 1:1811 GRAND CANAL BLVD
Practice Address - Street 2:#2
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207
Practice Address - Country:US
Practice Address - Phone:209-452-8996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician