Provider Demographics
NPI:1104205368
Name:GARRETT, ANDREW R (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:R
Last Name:GARRETT
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-3300
Mailing Address - Country:US
Mailing Address - Phone:619-532-9795
Mailing Address - Fax:619-532-7508
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-3300
Practice Address - Country:US
Practice Address - Phone:619-532-9795
Practice Address - Fax:619-532-7508
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2023-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
171000000X
UT13139587-12042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAD0000Medicare UPIN