Provider Demographics
NPI:1194181602
Name:GARNET TATTOO
Entity Type:Organization
Organization Name:GARNET TATTOO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-214-1311
Mailing Address - Street 1:1968 GARNET AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3555
Mailing Address - Country:US
Mailing Address - Phone:619-942-9737
Mailing Address - Fax:
Practice Address - Street 1:1968 GARNET AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3555
Practice Address - Country:US
Practice Address - Phone:619-942-9737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, MedicalGroup - Single Specialty