Healthcare Provider Details

I. General information

NPI: 1104205368
Provider Name (Legal Business Name): ANDREW R GARRETT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR INTERNAL MEDICINE
SAN DIEGO CA
92134-3300
US

IV. Provider business mailing address

34800 BOB WILSON DR INTERNAL MEDICINE
SAN DIEGO CA
92134-3300
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-9795
  • Fax: 619-532-7508
Mailing address:
  • Phone: 619-532-9795
  • Fax: 619-532-7508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number13139587-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: