Healthcare Provider Details

I. General information

NPI: 1801763412
Provider Name (Legal Business Name): JONATHAN GARVIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 TURK ST
SAN FRANCISCO CA
94102-3703
US

IV. Provider business mailing address

1355 37TH AVE
SAN FRANCISCO CA
94122-1333
US

V. Phone/Fax

Practice location:
  • Phone: 415-917-3410
  • Fax:
Mailing address:
  • Phone: 310-993-0846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: