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General NPI Number Information
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NPI Number | 1053774679
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Entity Type | Individual
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Provider Name | GARRETT SEVIGNY M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 1346 FOOTHILL BLVD STE 201
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City | LA CANADA
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State | CA
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Zip | 91011-2143
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Country | US
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Telephone | 818-790-5583
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Fax |
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Provider Business Mailing Address
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Address Line | 400 N PEPPER AVE STE 2M203
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City | COLTON
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State | CA
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Zip | 92324-1801
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A162345
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License Number State | CA
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