Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | G45812 | CA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 35-049101 | OH |
N | 2081P2900X | Pain Medicine | 35-049101 | OH |
N | 2081P2900X | Pain Medicine | G45812 | CA |
NPI | 1326193624 |
---|---|
Provider Name | Dr. Virginia Ellen Garrett |
First Address | Riverside, CA 92506-2928 |
Second Address | Riverside, CA 92506-2928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 12/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0653163 | (05) | OH |
35-049101 | (05) | OH |
C65922 | (02) | CA |