MEDICARE: MRS. NANCY NINA GARRETTT P.A.

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	363AM0700X	Medical Physician Assistant	PA01124	CA

General Provider Information

NPI Number	:	1881732741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY NINA GARRETTT P.A.

Provider Business Mailing Address
First Line	:	3125 KALLIN AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-4204
Country	:	US
Telephone Number	:	213-923-4074
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 W 1ST ST STE K
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92703-3516
Country	:	US
Telephone Number	:	714-547-7745
Fax Number	:

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/09/2007

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