Provider Demographics
NPI:1396471082
Name:GARWOOD, WESLEY PAUL (PA)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:PAUL
Last Name:GARWOOD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 GRANITE GLEN CT
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6778
Mailing Address - Country:US
Mailing Address - Phone:925-216-1623
Mailing Address - Fax:
Practice Address - Street 1:5901 GRANITE GLEN CT
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6778
Practice Address - Country:US
Practice Address - Phone:925-216-1623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant