Healthcare Provider Details

I. General information

NPI: 1528803814
Provider Name (Legal Business Name): JESSICA GARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5241 N MAPLE AVE
FRESNO CA
93740-0001
US

IV. Provider business mailing address

3111 REDWOOD CIR
MARINA CA
93933-3215
US

V. Phone/Fax

Practice location:
  • Phone: 559-278-4240
  • Fax:
Mailing address:
  • Phone: 831-601-9104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: