Provider Demographics
NPI:1689944639
Name:TABIGO ON, ROY EUGENE GARIBAY (MD)
Entity Type:Individual
Prefix:
First Name:ROY EUGENE
Middle Name:GARIBAY
Last Name:TABIGO ON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 N MERCEY SPRINGS RD
Mailing Address - Street 2:UNIT C
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-7416
Mailing Address - Country:US
Mailing Address - Phone:917-455-6483
Mailing Address - Fax:
Practice Address - Street 1:311 W I ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3479
Practice Address - Country:US
Practice Address - Phone:209-826-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120169208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice