Healthcare Provider Details

I. General information

NPI: 1053774679
Provider Name (Legal Business Name): GARRETT SEVIGNY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 FOOTHILL BLVD STE 201
LA CANADA CA
91011-2143
US

IV. Provider business mailing address

400 N PEPPER AVE STE 2M203
COLTON CA
92324-1801
US

V. Phone/Fax

Practice location:
  • Phone: 818-790-5583
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA162345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: