MEDICARE: D E GARRISON DO INC

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	261QH0100X	Health Service Clinic/Center
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1811517832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D E GARRISON DO INC

Provider Business Mailing Address
First Line	:	PO BOX 35
Second Line	:
City	:	SUNSET BEACH
State	:	CA
Zip	:	90742-0035
Country	:	US
Telephone Number	:	661-387-5211
Fax Number	:

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	:	661-387-5211
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DOUGLAS GARRISON
Credential	:	DO
Telephone Number	:	661-387-5211

Provider Enumeration Date	:	04/20/2020
Last Update Date	:	10/12/2022

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Directions to “D E GARRISON DO INC ” Practice Location

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