Healthcare Provider Details

I. General information

NPI: 1922452606
Provider Name (Legal Business Name): MS. ASHLEY GARISPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PEPPER AVE
COLTON CA
92324-1801
US

IV. Provider business mailing address

180 E 21ST ST APT E1
COSTA MESA CA
92627-7129
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-1862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberD8670534
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A16685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: