Provider Demographics
NPI:1003286022
Name:GARNETT, KEVIN (HAD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:GARNETT
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 LONE TREE WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-6205
Mailing Address - Country:US
Mailing Address - Phone:925-778-3298
Mailing Address - Fax:
Practice Address - Street 1:4045 LONE TREE WAY
Practice Address - Street 2:SUITE D
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531
Practice Address - Country:US
Practice Address - Phone:925-778-3298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 8011237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist