Healthcare Provider Details

I. General information

NPI: 1508761602
Provider Name (Legal Business Name): ELSON SAMPSON GARRETT III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12640 HESPERIA RD
VICTORVILLE CA
92395-7753
US

IV. Provider business mailing address

14064 PADDOCK RD
VICTORVILLE CA
92394-7425
US

V. Phone/Fax

Practice location:
  • Phone: 760-684-8999
  • Fax:
Mailing address:
  • Phone: 951-243-4796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: