Provider Demographics
NPI:1922662436
Name:GARAYALDE, BARBARA J
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:GARAYALDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 N DUTTON AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-7121
Mailing Address - Country:US
Mailing Address - Phone:707-568-2300
Mailing Address - Fax:707-568-2304
Practice Address - Street 1:1260 N DUTTON AVE STE 105
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-7121
Practice Address - Country:US
Practice Address - Phone:707-568-2300
Practice Address - Fax:707-568-2304
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty