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NPI Code Detail

MEDICARE: KEVIN IAN GARIBAY I

MEDICARE: KEVIN IAN GARIBAY I
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCSW102021CA

General Provider Information

NPI Number : 1295252856
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN IAN GARIBAY I
Provider Business Mailing Address
First Line : 228 ELLINGBROOK DR
Second Line :
City : MONTEBELLO
State : CA
Zip : 90640-2108
Country : US
Telephone Number : 626-478-5141
Fax Number :
Provider Business Practice Location Address
First Line : 11731 TELEGRAPH RD STE G
Second Line :
City : SANTA FE SPRINGS
State : CA
Zip : 90670-6819
Country : US
Telephone Number : 562-942-8256
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2017
Last Update Date : 06/29/2021

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Directions to “ KEVIN IAN GARIBAY I ” Practice Location

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