Healthcare Provider Details

I. General information

NPI: 1710188875
Provider Name (Legal Business Name): JOHN C GARN SFIDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL CAMP PENDLETON BOX 555191
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

NAVAL HOSPITAL CAMP PENDLETON BOX 555191
CAMP PENDLETON CA
92055-5191
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-7135
  • Fax:
Mailing address:
  • Phone: 760-725-7135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: