Provider Demographics
NPI:1205065570
Name:GARRISON FAMILY MEDICAL GROUP CANYON COUNTRY
Entity type:Organization
Organization Name:GARRISON FAMILY MEDICAL GROUP CANYON COUNTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTONETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABATTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-947-7100
Mailing Address - Street 1:41210 11TH ST W
Mailing Address - Street 2:SUITE C
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1447
Mailing Address - Country:US
Mailing Address - Phone:661-947-7100
Mailing Address - Fax:661-947-5151
Practice Address - Street 1:18520 VIA PRINCESSA
Practice Address - Street 2:SUITE C
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-8326
Practice Address - Country:US
Practice Address - Phone:888-333-2996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARRISON FAMILY MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50780174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty