Healthcare Provider Details

I. General information

NPI: 1770690612
Provider Name (Legal Business Name): ROXANNE O. GARBEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COFFEE ROAD
MODESTO CA
95355-2803
US

IV. Provider business mailing address

2100 POWELL ST SUITE 920
EMERYVILLE CA
94608-1826
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-4500
  • Fax:
Mailing address:
  • Phone: 510-350-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: