Provider Demographics
NPI:1457461659
Name:GARRIDO, JOSE LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:GARRIDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:L
Other - Last Name:GARRIDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2821 ANGUILLA CT
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-6703
Mailing Address - Country:US
Mailing Address - Phone:812-205-1608
Mailing Address - Fax:
Practice Address - Street 1:3400 NEW HARTFORD RD
Practice Address - Street 2:SUITE A
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1705
Practice Address - Country:US
Practice Address - Phone:270-684-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12122261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health