Healthcare Provider Details

I. General information

NPI: 1689002065
Provider Name (Legal Business Name): BETTY JEAN GARFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETTY JEAN MATTHIAS

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WOOD ST
EUREKA CA
95501-4413
US

IV. Provider business mailing address

720 WOOD ST
EUREKA CA
95501-4413
US

V. Phone/Fax

Practice location:
  • Phone: 707-268-2990
  • Fax:
Mailing address:
  • Phone: 707-268-2990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-TQVAPE
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: