Provider Demographics
NPI:1023682481
Name:IBANEZ VALERA, GAFARY (CAREGIVER, DA)
Entity type:Individual
Prefix:
First Name:GAFARY
Middle Name:
Last Name:IBANEZ VALERA
Suffix:
Gender:F
Credentials:CAREGIVER, DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8902 W ROMA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-1735
Mailing Address - Country:US
Mailing Address - Phone:480-238-1223
Mailing Address - Fax:
Practice Address - Street 1:8902 W ROMA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-1735
Practice Address - Country:US
Practice Address - Phone:480-238-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 104100000X, 126800000X, 376J00000X
AZ2880653747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No126800000XDental ProvidersDental AssistantGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty