Healthcare Provider Details

I. General information

NPI: 1154752210
Provider Name (Legal Business Name): ANTONIO GARIBALDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 05/14/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 12TH ST STE B
MARINA CA
93933-6003
US

IV. Provider business mailing address

299 12TH ST STE B
MARINA CA
93933-6003
US

V. Phone/Fax

Practice location:
  • Phone: 831-883-3030
  • Fax: 831-883-3032
Mailing address:
  • Phone: 831-883-3030
  • Fax: 831-883-3032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: