Provider Demographics
NPI: | 1659462182 |
---|---|
Name: | GARNEAU, LOUIS KENNETH (ORTHO PA C) |
Entity Type: | Individual |
Prefix: | |
First Name: | LOUIS |
Middle Name: | KENNETH |
Last Name: | GARNEAU |
Suffix: | |
Gender: | M |
Credentials: | ORTHO PA C |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 632 W GIBSON RD |
Mailing Address - Street 2: | |
Mailing Address - City: | WOODLAND |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95695-5169 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 530-666-1631 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 632 W GIBSON RD |
Practice Address - Street 2: | |
Practice Address - City: | WOODLAND |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95695-5169 |
Practice Address - Country: | US |
Practice Address - Phone: | 530-666-1631 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-28 |
Last Update Date: | 2011-01-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | PA16153 | 363AS0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | P00745203 | Other | MEDICARE RAILROAD CARRIER |
CA | PA16153 | Other | MEDI-CAL |
CA | Q44522 | Medicare UPIN | |
CA | P00745203 | Other | MEDICARE RAILROAD CARRIER |
CA | AO321Z | Medicare PIN |