Healthcare Provider Details

I. General information

NPI: 1407350622
Provider Name (Legal Business Name): ASHTON MARK GARBUTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11333 SEPULVEDA BLVD
MISSION HILLS CA
91345-1116
US

IV. Provider business mailing address

11333 SEPULVEDA BLVD
MISSION HILLS CA
91345-1116
US

V. Phone/Fax

Practice location:
  • Phone: 818-869-7254
  • Fax:
Mailing address:
  • Phone: 818-869-7254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA165899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: