MEDICARE: DIANA MOCTEZUMA GARIBAY

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	106E00000X	Assistant Behavior Analyst	RBT-24-389694	CA
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1861252884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA MOCTEZUMA GARIBAY

Provider Business Mailing Address
First Line	:	16800 CLINTON AVE
Second Line	:
City	:	ASHLAND
State	:	CA
Zip	:	94578-2414
Country	:	US
Telephone Number	:	510-935-9112
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 PARK ST # 1099
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4507
Country	:	US
Telephone Number	:	888-428-3223
Fax Number	:

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

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	02/05/2026

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