Provider Demographics
NPI:1215511894
Name:GARINGO, MARICON BARBA (PT,DPT,GCS)
Entity type:Individual
Prefix:
First Name:MARICON
Middle Name:BARBA
Last Name:GARINGO
Suffix:
Gender:F
Credentials:PT,DPT,GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1072 MISTY CREEK ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2818
Mailing Address - Country:US
Mailing Address - Phone:619-823-2716
Mailing Address - Fax:619-934-0460
Practice Address - Street 1:1072 MISTY CREEK ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-2818
Practice Address - Country:US
Practice Address - Phone:619-823-2716
Practice Address - Fax:619-934-0460
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty