Provider Demographics
NPI:1851700124
Name:IBANEZ DE GARAYO, SARAH (ATC)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:IBANEZ DE GARAYO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1358 SILVER SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1515
Mailing Address - Country:US
Mailing Address - Phone:626-536-7956
Mailing Address - Fax:
Practice Address - Street 1:1358 SILVER SPRINGS DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1515
Practice Address - Country:US
Practice Address - Phone:626-536-7956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer