Healthcare Provider Details

I. General information

NPI: 1437399748
Provider Name (Legal Business Name): MICHAEL JAMES GARRETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 KETTNER BLVD SUITE 1A4
SAN DIEGO CA
92101-1250
US

IV. Provider business mailing address

PO BOX 211871
CHULA VISTA CA
91921-1871
US

V. Phone/Fax

Practice location:
  • Phone: 619-615-0701
  • Fax:
Mailing address:
  • Phone: 619-494-0485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: