Healthcare Provider Details

I. General information

NPI: 1356700512
Provider Name (Legal Business Name): ELIZABETH GARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14420 BLOSSOM HILL RD
LOS GATOS CA
95032-5120
US

IV. Provider business mailing address

2001 EUREKA CANYON RD
WATSONVILLE CA
95076-0158
US

V. Phone/Fax

Practice location:
  • Phone: 408-560-9298
  • Fax:
Mailing address:
  • Phone: 408-410-2527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: