Provider Demographics
NPI:1710237011
Name:GARRISON, CAITLIN GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:GRACE
Last Name:GARRISON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 WARNER AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4473
Mailing Address - Country:US
Mailing Address - Phone:714-316-0611
Mailing Address - Fax:714-520-0087
Practice Address - Street 1:4911 WARNER AVE STE 205
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-4473
Practice Address - Country:US
Practice Address - Phone:714-316-0611
Practice Address - Fax:714-520-0087
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22448363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant