Healthcare Provider Details

I. General information

NPI: 1427242361
Provider Name (Legal Business Name): ELIZABETH ANN GARNIER LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN DURAN LPT

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 B ST
SAN DIEGO CA
92101-4520
US

IV. Provider business mailing address

600 B ST
SAN DIEGO CA
92101-4520
US

V. Phone/Fax

Practice location:
  • Phone: 619-916-0439
  • Fax: 619-615-3197
Mailing address:
  • Phone: 619-916-0439
  • Fax: 619-615-3197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number29961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: