Healthcare Provider Details

I. General information

NPI: 1548942709
Provider Name (Legal Business Name): ELIZABETH GARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23745 PALA LN
APPLE VALLEY CA
92307-6795
US

IV. Provider business mailing address

23745 PALA LN
APPLE VALLEY CA
92307-6795
US

V. Phone/Fax

Practice location:
  • Phone: 951-809-9238
  • Fax:
Mailing address:
  • Phone: 951-809-9238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220271605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: