Provider Demographics
NPI:1619135209
Name:NORVELL, GARRETT DEAN CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:DEAN CHARLES
Last Name:NORVELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 VIBORG RD
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-2220
Mailing Address - Country:US
Mailing Address - Phone:805-686-3989
Mailing Address - Fax:
Practice Address - Street 1:2050 VIBORG RD
Practice Address - Street 2:
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2220
Practice Address - Country:US
Practice Address - Phone:805-686-3989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.132253207P00000X
CAA116771207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFE581ZMedicare PIN