Healthcare Provider Details

I. General information

NPI: 1821051889
Provider Name (Legal Business Name): DIANE GARIBALDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 TULLY RD CHABOYA CLINIC- PEDIATRICS DEPARTMENT
SAN JOSE CA
95111-1917
US

IV. Provider business mailing address

219 PURPLE GLEN DR
SAN JOSE CA
95119-1533
US

V. Phone/Fax

Practice location:
  • Phone: 408-817-1426
  • Fax:
Mailing address:
  • Phone: 408-972-9255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG50536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: