Healthcare Provider Details

I. General information

NPI: 1780324814
Provider Name (Legal Business Name): JERANIA LIZETH DE DIOS GARIBAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 LAUREL HILLS DR
SACRAMENTO CA
95841-3105
US

IV. Provider business mailing address

2871 JOSEPH AVE
SACRAMENTO CA
95864-7729
US

V. Phone/Fax

Practice location:
  • Phone: 916-281-1621
  • Fax:
Mailing address:
  • Phone: 707-640-9116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberE1188360
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberE1188360
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: