Healthcare Provider Details

I. General information

NPI: 1801984679
Provider Name (Legal Business Name): LIANA GARRETT RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ROSECRANS AVE # 3230
EL SEGUNDO CA
90245-4749
US

IV. Provider business mailing address

5035 AVENUE B
TORRANCE CA
90505-2106
US

V. Phone/Fax

Practice location:
  • Phone: 323-628-8671
  • Fax:
Mailing address:
  • Phone: 310-540-9554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0124669
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 362492
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN 362492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: