Healthcare Provider Details

I. General information

NPI: 1326193624
Provider Name (Legal Business Name): VIRGINIA ELLEN GARRETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 MCCRAY ST
RIVERSIDE CA
92506-2928
US

IV. Provider business mailing address

3737 MCCRAY ST
RIVERSIDE CA
92506-2928
US

V. Phone/Fax

Practice location:
  • Phone: 951-823-0266
  • Fax: 951-823-0266
Mailing address:
  • Phone: 951-823-0266
  • Fax: 951-823-0266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberG45812
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberG45812
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License NumberG45812
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG45812
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35-049101
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number35-049101
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number35-049101
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number35-049101
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number35-049101
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: