Provider Demographics
NPI:1780734459
Name:GARIBAY, FIDEL
Entity type:Individual
Prefix:MR
First Name:FIDEL
Middle Name:
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 1:4839 E HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-3006
Mailing Address - Country:US
Mailing Address - Phone:559-286-6249
Mailing Address - Fax:
Practice Address - Street 1:153 N U ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2438
Practice Address - Country:US
Practice Address - Phone:559-445-9094
Practice Address - Fax:559-445-9083
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6020871735101YM0800X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health