Provider Demographics
NPI:1174836415
Name:CARYN GARRIGA MD LLC
Entity Type:Organization
Organization Name:CARYN GARRIGA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRIGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-527-8900
Mailing Address - Street 1:249 CLARKSON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2219
Mailing Address - Country:US
Mailing Address - Phone:636-527-8900
Mailing Address - Fax:636-527-8912
Practice Address - Street 1:249 CLARKSON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2219
Practice Address - Country:US
Practice Address - Phone:636-527-8900
Practice Address - Fax:636-527-8912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003014162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207507807Medicaid