Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1558932301 |
---|---|
Provider Name | Linda Garrett |
First Address | Larkspur, CA 94939-1490 |
Second Address | Larkspur, CA 94939-1490 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2021 |
Last Update Date | 02/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
829183123 | (05) | CA |