Healthcare Provider Details

I. General information

NPI: 1538168067
Provider Name (Legal Business Name): KAREN SUE GARN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39141 CIVIC CENTER DR STE 335
FREMONT CA
94538-5878
US

IV. Provider business mailing address

39141 CIVIC CENTER DR STE 335
FREMONT CA
94538-5878
US

V. Phone/Fax

Practice location:
  • Phone: 510-248-1414
  • Fax: 510-797-5850
Mailing address:
  • Phone: 510-248-1414
  • Fax: 510-797-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9105108
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberA447
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number447
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number54269
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: