Provider Demographics
NPI:1225528169
Name:GARVINE, BRET
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:
Last Name:GARVINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3248 BRIGGS AVE APT B
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4848
Mailing Address - Country:US
Mailing Address - Phone:510-523-4143
Mailing Address - Fax:510-523-4829
Practice Address - Street 1:3248 BRIGGS AVE APT B
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4848
Practice Address - Country:US
Practice Address - Phone:510-523-4143
Practice Address - Fax:510-523-4829
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies