MEDICARE: CARLOS GARRETT M.D.

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	207R00000X	Internal Medicine Physician	G058607	CA

General Provider Information

NPI Number	:	1992714257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS GARRETT M.D.

Provider Business Mailing Address
First Line	:	1300 LORETO DR
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91207-1844
Country	:	US
Telephone Number	:	626-961-1152
Fax Number	:	626-330-0242

Provider Business Practice Location Address
First Line	:	15707 VALLEY BLVD
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91744-3932
Country	:	US
Telephone Number	:	626-961-1152
Fax Number	:	626-330-0242

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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