Healthcare Provider Details

I. General information

NPI: 1235314089
Provider Name (Legal Business Name): ANN MARIE GARIBALDI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 HUALAPAI MOUNTAIN RD STE 101
KINGMAN AZ
86401-8374
US

IV. Provider business mailing address

1739 E BEVERLY AVE STE 200
KINGMAN AZ
86409-3593
US

V. Phone/Fax

Practice location:
  • Phone: 928-681-8530
  • Fax: 928-681-8714
Mailing address:
  • Phone: 928-263-4722
  • Fax: 928-263-4794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1953
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4249
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: