MEDICARE: CAITLIN GRACE GARRISON PA-C

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	22448	CA

General Provider Information

NPI Number	:	1710237011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN GRACE GARRISON PA-C

Provider Business Mailing Address
First Line	:	4911 WARNER AVE STE 205
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-4473
Country	:	US
Telephone Number	:	714-316-0611
Fax Number	:	714-520-0087

Provider Business Practice Location Address
First Line	:	4911 WARNER AVE STE 205
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-4473
Country	:	US
Telephone Number	:	714-316-0611
Fax Number	:	714-520-0087

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

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	04/14/2021

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