Provider Demographics
NPI:1326193624
Name:GARRETT, VIRGINIA ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:ELLEN
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 MCCRAY ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2928
Mailing Address - Country:US
Mailing Address - Phone:951-823-0266
Mailing Address - Fax:951-823-0266
Practice Address - Street 1:3737 MCCRAY ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2928
Practice Address - Country:US
Practice Address - Phone:951-823-0266
Practice Address - Fax:951-823-0266
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45812204C00000X, 2081P0004X, 2081P0010X, 2081P2900X
OH35-049101208100000X, 2081P0010X, 2081P2900X, 2081P0004X, 2081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35-049101Medicaid
OH0653163Medicaid
OH0653163Medicaid
CAC65922Medicare UPIN
OH35-049101Medicare PIN
CA00G458120Medicare PIN