Provider Demographics
NPI:1710175799
Name:WDOWIN, GARRETT EMANON (NMD)
Entity Type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:EMANON
Last Name:WDOWIN
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2121 E COAST HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1934
Mailing Address - Country:US
Mailing Address - Phone:949-640-0096
Mailing Address - Fax:949-281-5334
Practice Address - Street 1:2121 E COAST HWY STE 210
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-1934
Practice Address - Country:US
Practice Address - Phone:949-933-6852
Practice Address - Fax:949-281-5334
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1955175F00000X
VT099-0000227175F00000X
AZ07-1038175F00000X
CA413175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath