Healthcare Provider Details

I. General information

NPI: 1942521877
Provider Name (Legal Business Name): VIRGINIA GARRETT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 04/25/2014
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 TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35049101
License Number StateOH

VIII. Authorized Official

Name: DR. VIRGINIA ELLEN GARRETT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-823-0266