MEDICARE: PHILLIP STEPHEN GARIBOTTO NP

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
1	363LP2300X	Primary Care Nurse Practitioner	95010395	CA

General Provider Information

NPI Number	:	1386107712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP STEPHEN GARIBOTTO NP

Provider Business Mailing Address
First Line	:	4527 CONTOUR BLVD APT 8
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3467
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5090 SHOREHAM PL STE 209
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-5935
Country	:	US
Telephone Number	:	858-455-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2019
Last Update Date	:	04/11/2019

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