MEDICARE: GARVEY SCHOOL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN422810	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SS1964550	OTHER	CA	MEDI-CAL CHDP

General Provider Information

NPI Number	:	1407910250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARVEY SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	2730 DEL MAR AVE
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-3026
Country	:	US
Telephone Number	:	626-307-3427
Fax Number	:

Provider Business Practice Location Address
First Line	:	2730 DEL MAR AVE
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-3026
Country	:	US
Telephone Number	:	626-307-3427
Fax Number	:	626-307-3494

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MS. VIRGINIA PETERSON
Credential	:	M.A.
Telephone Number	:	626-307-3427

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	08/22/2020

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Directions to “GARVEY SCHOOL DISTRICT ” Practice Location

Language	Start Address	Practice Location

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