MEDICARE: STANLEY GARRIDO PA

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	363A00000X	Physician Assistant	110227	CA

General Provider Information

NPI Number	:	1457367351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY GARRIDO PA

Provider Business Mailing Address
First Line	:	10175 DIAMOND HEAD CT
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-5320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3544 30TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-4120
Country	:	US
Telephone Number	:	619-515-2424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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