Provider Demographics
NPI:1053930792
Name:GARIBAY, JESSIE
Entity type:Individual
Prefix:
First Name:JESSIE
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 1:7712 HONDO ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3408
Mailing Address - Country:US
Mailing Address - Phone:323-605-3483
Mailing Address - Fax:
Practice Address - Street 1:7712 HONDO ST
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3408
Practice Address - Country:US
Practice Address - Phone:323-605-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst