Healthcare Provider Details

I. General information

NPI: 1023682481
Provider Name (Legal Business Name): GAFARY IBANEZ VALERA CAREGIVER, DA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 04/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8902 W ROMA AVE
PHOENIX AZ
85037-1735
US

IV. Provider business mailing address

8902 W ROMA AVE
PHOENIX AZ
85037-1735
US

V. Phone/Fax

Practice location:
  • Phone: 480-238-1223
  • Fax:
Mailing address:
  • Phone: 480-238-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number288065
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: